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General NPI Number Information
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NPI Number | 1154597797
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Entity Type | Individual
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Provider Name | KIMBERLY BURGESS BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/04/2008
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Last Update Date | 05/04/2008
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Provider Practice Location Address
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Address Line | 156 BURNETTS WAY
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City | SUFFOLK
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State | VA
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Zip | 23434-8166
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Country | US
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Telephone | 757-934-6470
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Fax | 757-255-4281
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Provider Business Mailing Address
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Address Line | 1011 CHERRY GROVE RD N
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City | SUFFOLK
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State | VA
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Zip | 23432-1811
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Country | US
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Telephone | 757-934-6470
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Fax | 757-255-4281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1-07-3299
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License Number State |
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