Provider Demographics
NPI:1083795108
Name:BURKHOLDER, KRISTEN R (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:R
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033-0368
Mailing Address - Country:US
Mailing Address - Phone:928-697-4000
Mailing Address - Fax:928-697-4052
Practice Address - Street 1:HWY 98 & NAVAJO ROUTE 16
Practice Address - Street 2:
Practice Address - City:SHONTO
Practice Address - State:AZ
Practice Address - Zip Code:86044-7397
Practice Address - Country:US
Practice Address - Phone:928-672-3000
Practice Address - Fax:928-697-3005
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ981482Medicaid
AZ981482Medicaid
AZHSZ045Medicare PIN
AZI47198Medicare UPIN
AZ060012Medicaid