Provider Demographics
NPI:1215052964
Name:BURKHART, KRISTI NICOLE (DO)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:NICOLE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-355-9233
Mailing Address - Fax:512-355-9230
Practice Address - Street 1:160 N LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605-4323
Practice Address - Country:US
Practice Address - Phone:512-355-9233
Practice Address - Fax:512-355-9230
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5877Medicare UPIN
TX199268701Medicaid