Provider Demographics
NPI:1528034865
Name:BURNLEY, KATHLEEN MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MICHELLE
Last Name:BURNLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5620 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2273
Mailing Address - Country:US
Mailing Address - Phone:804-767-8400
Mailing Address - Fax:
Practice Address - Street 1:5620 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2273
Practice Address - Country:US
Practice Address - Phone:804-767-8400
Practice Address - Fax:804-262-5113
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52860207Q00000X
CT63817207Q00000X
LA312663207Q00000X
FLME141661207Q00000X
GA83392207Q00000X
VA0101247204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02543039Medicaid
NYI00189Medicare UPIN
NY02543039Medicaid