Provider Demographics
NPI:1104558295
Name:BURDINE, KAREN DENISE
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DENISE
Last Name:BURDINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-4929
Mailing Address - Country:US
Mailing Address - Phone:901-406-9974
Mailing Address - Fax:
Practice Address - Street 1:662 STONEWALL ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-4929
Practice Address - Country:US
Practice Address - Phone:901-406-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN220004056342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company