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NPI Code Detail

MEDICARE: KRISTEN ALEXA BURNETT PSY.D., LP

MEDICARE: KRISTEN ALEXA BURNETT PSY.D., LP
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
1103TC0700XClinical Psychologist4651MN

General Provider Information

NPI Number : 1699823237
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN ALEXA BURNETT PSY.D., LP
Provider Business Mailing Address
First Line : 11505 36TH AVE N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2304
Country : US
Telephone Number : 763-509-3818
Fax Number : 763-559-0149
Provider Business Practice Location Address
First Line : 11505 36TH AVE N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2304
Country : US
Telephone Number : 763-509-3818
Fax Number : 763-559-0149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 07/08/2007

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