Provider Demographics
NPI:1306553417
Name:BURTON, KATHLEEN NICOLE (CNA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NICOLE
Last Name:BURTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:NICOLE
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1024 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2057
Mailing Address - Country:US
Mailing Address - Phone:937-539-8528
Mailing Address - Fax:
Practice Address - Street 1:1024 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2057
Practice Address - Country:US
Practice Address - Phone:937-539-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602483100622251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health