Healthcare Provider Details

I. General information

NPI: 1528034865
Provider Name (Legal Business Name): KATHLEEN MICHELLE BURNLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 BROOK RD
RICHMOND VA
23227-2273
US

IV. Provider business mailing address

5620 BROOK RD
RICHMOND VA
23227-2273
US

V. Phone/Fax

Practice location:
  • Phone: 804-767-8400
  • Fax: 804-262-5113
Mailing address:
  • Phone: 804-767-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52860
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63817
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number312663
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME141661
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83392
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101247204
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: