Provider Demographics
NPI:1598486938
Name:BURGIN, KIRA RYNEA (ATC)
Entity type:Individual
Prefix:MRS
First Name:KIRA
Middle Name:RYNEA
Last Name:BURGIN
Suffix:
Gender:
Credentials:ATC
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:RYNEA
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28826 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-2337
Mailing Address - Country:US
Mailing Address - Phone:660-988-5190
Mailing Address - Fax:
Practice Address - Street 1:801 MEDICAL DR STE 400
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3824
Practice Address - Country:US
Practice Address - Phone:636-332-8455
Practice Address - Fax:636-332-8499
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230281432255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer