Provider Demographics
NPI:1467691576
Name:BURKHART, AMY ELLEN (MD, RD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELLEN
Last Name:BURKHART
Suffix:
Gender:F
Credentials:MD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 3RD ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2860
Mailing Address - Country:US
Mailing Address - Phone:707-927-5622
Mailing Address - Fax:707-927-5747
Practice Address - Street 1:1434 3RD ST STE 3A
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2860
Practice Address - Country:US
Practice Address - Phone:707-927-5622
Practice Address - Fax:707-927-5747
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
CAA061842207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered