Provider Demographics
NPI:1174222137
Name:BURKHOLDER, NA YEUN PARK (NP)
Entity type:Individual
Prefix:
First Name:NA YEUN
Middle Name:PARK
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NA YEUN
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8105 FREEMAN DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-3918
Mailing Address - Country:US
Mailing Address - Phone:804-704-5407
Mailing Address - Fax:
Practice Address - Street 1:UNIT 15245
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271-5245
Practice Address - Country:US
Practice Address - Phone:315-737-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046523163W00000X, 363LF0000X
NY745806163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse