Provider Demographics
NPI:1033463468
Name:BURKE-GULLETT, KRISTY (RRT, RPSGT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:BURKE-GULLETT
Suffix:
Gender:F
Credentials:RRT, RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 DOGWOOD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-7462
Mailing Address - Country:US
Mailing Address - Phone:601-218-6300
Mailing Address - Fax:
Practice Address - Street 1:114 MONUMENT PL
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5169
Practice Address - Country:US
Practice Address - Phone:601-218-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2278P1004X, 227900000X, 2279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Diagnostics
No2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation