Healthcare Provider Details

I. General information

NPI: 1346164480
Provider Name (Legal Business Name): KELLY ANN BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 REGIMENTAL RD
KING OF PRUSSIA PA
19406-1563
US

IV. Provider business mailing address

425 REGIMENTAL RD
KING OF PRUSSIA PA
19406-1563
US

V. Phone/Fax

Practice location:
  • Phone: 484-919-2518
  • Fax:
Mailing address:
  • Phone: 484-919-2518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-350742
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: