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General NPI Number Information
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NPI Number | 1184351900
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Entity Type | Individual
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Provider Name | KENDRA LEE BURGOON
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Gender | Female
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 801 N CALIFORNIA ST
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City | SOCORRO
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State | NM
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Zip | 87801-4254
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Country | US
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Telephone | 575-838-8991
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Fax | 575-838-0423
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Provider Business Mailing Address
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Address Line | 1894 CHAPARRAL LOOP
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City | SOCORRO
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State | NM
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Zip | 87801-3718
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Country | US
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Telephone | 575-838-8991
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Fax | 575-838-0423
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | NM
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