Provider Demographics
NPI:1790651875
Name:BURKHARDT, KELLI JEAN
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:JEAN
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 TURNBULL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2343
Mailing Address - Country:US
Mailing Address - Phone:513-387-0897
Mailing Address - Fax:513-387-0897
Practice Address - Street 1:1758 TURNBULL RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2343
Practice Address - Country:US
Practice Address - Phone:513-387-0897
Practice Address - Fax:513-387-0897
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator