Provider Demographics
NPI:1790679074
Name:BURNS, KATHLEEN (CLC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N O ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2823
Mailing Address - Country:US
Mailing Address - Phone:801-960-6992
Mailing Address - Fax:
Practice Address - Street 1:546 N O ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2823
Practice Address - Country:US
Practice Address - Phone:801-960-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
364578174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN