Provider Demographics
NPI:1972073013
Name:BURKETT, KAYLAN JOY (NP)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:JOY
Last Name:BURKETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 S 167TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7313
Mailing Address - Country:US
Mailing Address - Phone:810-874-1190
Mailing Address - Fax:
Practice Address - Street 1:14420 W MEEKER BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5288
Practice Address - Country:US
Practice Address - Phone:623-267-6700
Practice Address - Fax:623-267-6701
Is Sole Proprietor?:No
Enumeration Date:2018-12-02
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily