MEDICARE: ANNA KATE BURKE

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	23278008	LA

General Provider Information

NPI Number	:	1760229587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA KATE BURKE

Provider Business Mailing Address
First Line	:	9400 PARK BLUFF TER
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23838-8957
Country	:	US
Telephone Number	:	318-455-0132
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 TEMPLE LAKE DR STE 5
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-4902
Country	:	US
Telephone Number	:	318-455-0132
Fax Number	:

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

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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