Provider Demographics
NPI:1558569665
Name:BURDICK, KIM (WHCNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BURDICK
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2382
Mailing Address - Country:US
Mailing Address - Phone:214-947-6700
Mailing Address - Fax:214-947-6701
Practice Address - Street 1:122 W COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2382
Practice Address - Country:US
Practice Address - Phone:214-947-6700
Practice Address - Fax:214-947-6701
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109765363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042494704Medicaid
TX042494708Medicaid
TX042494703Medicaid
TX042494705Medicaid
TX042494707Medicaid
TX042494709Medicaid
TX042494711Medicaid
TX042494702Medicaid
TX042494706Medicaid
TX042494710Medicaid
TX8Y2093OtherBLUE CROSS BLUE SHIELD