MEDICARE: MRS. SHIRLEY KATHERINE BURKETT FNP

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	363L00000X	Nurse Practitioner	662670	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8N7088	OTHER	TX	BLUE CROSS BLUE SHIELD
2	8Y4029	OTHER	TX	BCBS PVN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528068772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRLEY KATHERINE BURKETT FNP

Provider Business Mailing Address
First Line	:	9 GREENWAY PLZ
Second Line	:	SUITE 2950
City	:	HOUSTON
State	:	TX
Zip	:	77046-0905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 SOUTH FM 1626
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-0000
Country	:	US
Telephone Number	:	512-268-1940
Fax Number	:	512-268-5186

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/07/2009

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