Provider Demographics
NPI:1235791450
Name:BURLEY, KENARD
Entity Type:Individual
Prefix:
First Name:KENARD
Middle Name:
Last Name:BURLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 COUNTY ROAD 4106
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-5007
Mailing Address - Country:US
Mailing Address - Phone:972-472-3815
Mailing Address - Fax:972-472-3814
Practice Address - Street 1:553 COUNTY ROAD 4106
Practice Address - Street 2:
Practice Address - City:CRANDALL
Practice Address - State:TX
Practice Address - Zip Code:75114-5007
Practice Address - Country:US
Practice Address - Phone:972-472-3815
Practice Address - Fax:972-472-3814
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications