Provider Demographics
NPI:1437848660
Name:BURGESS, KRISTEN (HEALTH EDUCATOR)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9562 M 113 E
Mailing Address - Street 2:
Mailing Address - City:FIFE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49633-9368
Mailing Address - Country:US
Mailing Address - Phone:231-570-0727
Mailing Address - Fax:
Practice Address - Street 1:9562 M 113 E
Practice Address - Street 2:
Practice Address - City:FIFE LAKE
Practice Address - State:MI
Practice Address - Zip Code:49633-9368
Practice Address - Country:US
Practice Address - Phone:231-570-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula