Healthcare Provider Details

I. General information

NPI: 1457837353
Provider Name (Legal Business Name): DUSTIN NICHOLAS BURKMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E SCHOOL AVE
VISALIA CA
93291-5032
US

IV. Provider business mailing address

1902 S BARDO ST
VISALIA CA
93277-4851
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: