MEDICARE: BROOKLYN BURKHART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1205471661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYN BURKHART

Provider Business Mailing Address
First Line	:	971 E WICHITA AVE
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2444
Country	:	US
Telephone Number	:	785-657-7464
Fax Number	:	785-445-4042

Provider Business Practice Location Address
First Line	:	3706 MEADOWLARK LN
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-7465
Country	:	US
Telephone Number	:	785-657-7464
Fax Number	:	785-445-4042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	05/11/2026

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Directions to “ BROOKLYN BURKHART ” Practice Location

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