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General NPI Number Information
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NPI Number | 1730675265
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Entity Type | Individual
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Provider Name | KAITLIN BURDETTE
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Gender | Female
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 1011 E MAIN ST STE 210B
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City | RICHMOND
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State | VA
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Zip | 23219-3546
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Country | US
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Telephone | 571-419-2892
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Fax |
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Provider Business Mailing Address
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Address Line | 10200 FOREST GREEN BLVD STE 112
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City | LOUISVILLE
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State | KY
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Zip | 40223-5167
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Country | US
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Telephone |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 262122
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LBA453
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133001109
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License Number State | VA
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