Provider Demographics
NPI:1487704524
Name:BURNER, KIMBERLY DAWN (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:BURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:870-856-2107
Practice Address - Street 1:16723 HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:AR
Practice Address - Zip Code:72732-7007
Practice Address - Country:US
Practice Address - Phone:479-359-2151
Practice Address - Fax:870-895-2164
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART2011-034207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine