Healthcare Provider Details

I. General information

NPI: 1962381707
Provider Name (Legal Business Name): KJB HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 EDGEWATER RD
PASADENA MD
21122-5632
US

IV. Provider business mailing address

518 EDGEWATER RD
PASADENA MD
21122-5632
US

V. Phone/Fax

Practice location:
  • Phone: 443-812-9735
  • Fax:
Mailing address:
  • Phone: 443-812-9735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN BURKHARDT
Title or Position: OWNER
Credential: NP
Phone: 443-812-9735