Provider Demographics
NPI:1427689603
Name:BURDETTE, KRISTEN POWELL (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:POWELL
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 ACKERMAN CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6419
Mailing Address - Country:US
Mailing Address - Phone:864-567-4348
Mailing Address - Fax:
Practice Address - Street 1:29 ROCKY SLOPE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3909
Practice Address - Country:US
Practice Address - Phone:864-663-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23022208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery