Provider Demographics
NPI:1417542739
Name:BURDEN, RHONDA LYNN (CSFA, KCSA)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:LYNN
Last Name:BURDEN
Suffix:
Gender:F
Credentials:CSFA, KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 BRASSFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-9056
Mailing Address - Country:US
Mailing Address - Phone:502-321-3555
Mailing Address - Fax:502-633-2258
Practice Address - Street 1:2777 BRASSFIELD CIR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9056
Practice Address - Country:US
Practice Address - Phone:502-321-3555
Practice Address - Fax:502-633-2258
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA313246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
177771OtherNBSTSA