Provider Demographics
NPI:1386843233
Name:BURCKARDT, ELIZABETH R (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:R
Last Name:BURCKARDT
Suffix:
Gender:F
Credentials:ARNP
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-852-5841
Mailing Address - Fax:502-852-1359
Practice Address - Street 1:401 E CHESTNUT ST UNIT 690
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5706
Practice Address - Country:US
Practice Address - Phone:502-852-5841
Practice Address - Fax:502-852-1359
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005218363LA2100X
KY3005216363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000626497OtherANTHEM
KY7100013980Medicaid
KY50025465OtherPASSPORT
KYP00824827OtherRAILROAD MEDICARE KY
KY50048427OtherPASSPORT - CTS
KY000000642019OtherANTHEM - NNIKY
KY000028412NOtherHUMANA - NNIKY
KY106198OtherSIHO
KY000028412NOtherHUMANA - NNIKY
KY000000626497OtherANTHEM