Healthcare Provider Details

I. General information

NPI: 1558097360
Provider Name (Legal Business Name): KAITLYN N BURKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 VILLAGE LN
MACUNGIE PA
18062-8484
US

IV. Provider business mailing address

2100 MACK BLVD
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-967-2772
  • Fax: 732-557-1083
Mailing address:
  • Phone: 848-844-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063807
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: