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NPI Code Detail

MEDICARE: KELLI BURGESS

MEDICARE: KELLI BURGESS
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
1101Y00000XCounselor
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518282227
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI BURGESS
Provider Business Mailing Address
First Line : 178 PRIVATE ROAD 19423
Second Line :
City : SOUTH POINT
State : OH
Zip : 45680-8831
Country : US
Telephone Number : 740-451-0741
Fax Number : 740-313-0426
Provider Business Practice Location Address
First Line : 178 PRIVATE ROAD 19423
Second Line :
City : SOUTH POINT
State : OH
Zip : 45680-8831
Country : US
Telephone Number : 740-451-0741
Fax Number : 740-313-0426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2010
Last Update Date : 11/25/2019

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Directions to “ KELLI BURGESS ” Practice Location

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