Provider Demographics
NPI:1417368739
Name:BURNS, KATHLEEN (DNP, RN)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:DNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2170
Mailing Address - Country:US
Mailing Address - Phone:330-721-5993
Mailing Address - Fax:
Practice Address - Street 1:1000 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2170
Practice Address - Country:US
Practice Address - Phone:330-978-4892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.229048 COA.12801364SA2100X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health