Provider Demographics
NPI:1316958770
Name:BURKHART, NUGGET TAYLOR (NP)
Entity type:Individual
Prefix:
First Name:NUGGET
Middle Name:TAYLOR
Last Name:BURKHART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CANYONWOOD CT APT 2
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-3635
Mailing Address - Country:US
Mailing Address - Phone:925-937-8747
Mailing Address - Fax:
Practice Address - Street 1:2238 GEARY BLVD # 5NW
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3416
Practice Address - Country:US
Practice Address - Phone:415-822-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704124126363L00000X
CARN 229200 NP 16404363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4290384Medicaid
MI4290384Medicaid