Provider Demographics
NPI:1164838595
Name:BURNS, KATHY L (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:BURNS
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 S MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2500
Mailing Address - Country:US
Mailing Address - Phone:208-610-7340
Mailing Address - Fax:208-920-6162
Practice Address - Street 1:606 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2500
Practice Address - Country:US
Practice Address - Phone:208-610-7340
Practice Address - Fax:208-920-6162
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60459854171100000X
IDACU-299171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist