Healthcare Provider Details

I. General information

NPI: 1033463468
Provider Name (Legal Business Name): KRISTY BURKE-GULLETT RRT, RPSGT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 MONUMENT PL
VICKSBURG MS
39180-5169
US

IV. Provider business mailing address

440 DOGWOOD LAKE DR
VICKSBURG MS
39183-7462
US

V. Phone/Fax

Practice location:
  • Phone: 601-218-6300
  • Fax:
Mailing address:
  • Phone: 601-218-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: