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General NPI Number Information
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NPI Number | 1174222137
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Entity Type | Individual
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Provider Name | NA YEUN PARK BURKHOLDER NP
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | UNIT 15245
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City | APO
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State | AP
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Zip | 96271-5245
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Country | US
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Telephone | 315-737-2019
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Fax |
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Provider Business Mailing Address
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Address Line | 8105 FREEMAN DR
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City | ROWLETT
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State | TX
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Zip | 75089-3918
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Country | US
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Telephone | 804-704-5407
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1046523
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1046523
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 745806
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License Number State | NY
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