Provider Demographics
NPI:1104696525
Name:BURNS, KATHLEEN NICHOLE (RN, CBC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NICHOLE
Last Name:BURNS
Suffix:
Gender:F
Credentials:RN, CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 RAZORBACK CIR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-4516
Mailing Address - Country:US
Mailing Address - Phone:903-733-6599
Mailing Address - Fax:
Practice Address - Street 1:1902 RAZORBACK CIR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-4516
Practice Address - Country:US
Practice Address - Phone:903-733-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR107572163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty