Provider Demographics
NPI:1164504429
Name:BURNS, KRISTEN JEAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JEAN
Last Name:BURNS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VILLAGE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-9092
Mailing Address - Country:US
Mailing Address - Phone:803-631-2858
Mailing Address - Fax:803-631-2862
Practice Address - Street 1:1200 VILLAGE HARBOR DR
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-9092
Practice Address - Country:US
Practice Address - Phone:803-631-2858
Practice Address - Fax:803-631-2862
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02299363LF0000X
SC109057363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592867AMedicare PIN