Healthcare Provider Details

I. General information

NPI: 1790624153
Provider Name (Legal Business Name): MR. KALEN WHITTAKER BURWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 VETERANS BLVD
BRYSON CITY NC
28713-8816
US

IV. Provider business mailing address

514 COAPMAN ST APT 2F
GREENSBORO NC
27407-1841
US

V. Phone/Fax

Practice location:
  • Phone: 828-538-4546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023555
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: