Healthcare Provider Details

I. General information

NPI: 1629432034
Provider Name (Legal Business Name): LYNDSEY BURIAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 KINGWOOD MEDICAL DR STE 200
KINGWOOD TX
77339-6408
US

IV. Provider business mailing address

451 KINGWOOD MEDICAL DR STE 200
KINGWOOD TX
77339-6408
US

V. Phone/Fax

Practice location:
  • Phone: 281-593-2421
  • Fax:
Mailing address:
  • Phone: 281-359-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA07851
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: