Healthcare Provider Details

I. General information

NPI: 1760047260
Provider Name (Legal Business Name): KRISTIE YVONNE BURKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE YVONNE TAYLOR

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CHERRY ST
BLUEFIELD WV
24701-3338
US

IV. Provider business mailing address

510 CHERRY ST
BLUEFIELD WV
24701-3338
US

V. Phone/Fax

Practice location:
  • Phone: 304-324-2661
  • Fax: 304-323-6016
Mailing address:
  • Phone: 304-324-2661
  • Fax: 304-323-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32475
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32475
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: