Provider Demographics
NPI:1407312192
Name:BURKE, KRISTEN PAULETTE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:PAULETTE
Last Name:BURKE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4647
Mailing Address - Country:US
Mailing Address - Phone:508-595-2700
Mailing Address - Fax:774-221-5136
Practice Address - Street 1:366 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4647
Practice Address - Country:US
Practice Address - Phone:508-595-2700
Practice Address - Fax:774-221-5136
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01912363LF0000X
MARN2305591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110151182AMedicaid