Healthcare Provider Details

I. General information

NPI: 1417889676
Provider Name (Legal Business Name): KRISTIN LEIGH BURTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ROSENWALD LN
BREVARD NC
28712-5211
US

IV. Provider business mailing address

1911 EVERETT RD
PISGAH FOREST NC
28768-8923
US

V. Phone/Fax

Practice location:
  • Phone: 828-884-6173
  • Fax:
Mailing address:
  • Phone: 828-577-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1211116
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: