Provider Demographics
NPI:1508591538
Name:BURLEY, KAMETRIC
Entity Type:Individual
Prefix:
First Name:KAMETRIC
Middle Name:
Last Name:BURLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 DENISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-3728
Mailing Address - Country:US
Mailing Address - Phone:501-516-6141
Mailing Address - Fax:
Practice Address - Street 1:7613 DENISE DRIVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3728
Practice Address - Country:US
Practice Address - Phone:501-516-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)