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General NPI Number Information
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NPI Number | 1306356670
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Entity Type | Individual
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Provider Name | KATHERINE LANE BILLS BURKARD PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 655 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 407-244-8227
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 NIRA ST
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8652
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Country | US
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Telephone | 904-387-4991
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9110786
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License Number State | FL
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