Healthcare Provider Details

I. General information

NPI: 1942580964
Provider Name (Legal Business Name): KATHLEEN BURKE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 EASTON DR
BAKERSFIELD CA
93309-1021
US

IV. Provider business mailing address

8302 ESPRESSO DR 100
BAKERSFIELD CA
93312-5687
US

V. Phone/Fax

Practice location:
  • Phone: 661-377-1700
  • Fax: 661-616-9199
Mailing address:
  • Phone: 661-377-1700
  • Fax: 661-616-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1036967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: