Provider Demographics
NPI:1407042468
Name:BURGESS, KRISTEN LEBEAU (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LEBEAU
Last Name:BURGESS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEBEAU
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-1821
Mailing Address - Country:US
Mailing Address - Phone:740-455-3304
Mailing Address - Fax:740-455-3686
Practice Address - Street 1:3620 COURT DR
Practice Address - Street 2:BLDG K
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6456
Practice Address - Country:US
Practice Address - Phone:740-454-1248
Practice Address - Fax:740-454-8183
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH318939363L00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2136709Medicaid