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NPI Code Detail

MEDICARE: KATHRYN GAULT BURNETT CPNP

MEDICARE: KATHRYN GAULT BURNETT CPNP
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
1363LP0200XPediatric Nurse Practitioner1248SC

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 : 1639123318
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN GAULT BURNETT CPNP
Provider Business Mailing Address
First Line : 300 E MCBEE AVE FL 4
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2842
Country : US
Telephone Number : 864-522-8603
Fax Number :
Provider Business Practice Location Address
First Line : 29 N ACADEMY ST
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2629
Country : US
Telephone Number : 864-331-1300
Fax Number : 864-331-1447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 05/28/2021

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