Healthcare Provider Details

I. General information

NPI: 1013684141
Provider Name (Legal Business Name): KATHRYN KENDALL BURKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S JACKSON ST
LOUISVILLE KY
40202-1622
US

IV. Provider business mailing address

550 S JACKSON ST
LOUISVILLE KY
40202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5666
  • Fax:
Mailing address:
  • Phone: 502-852-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-182138
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: