Provider Demographics
NPI:1609365469
Name:BURDETTE, KIMBERLY KAY (CRNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-9552
Mailing Address - Country:US
Mailing Address - Phone:717-372-6769
Mailing Address - Fax:
Practice Address - Street 1:302 PINETOWN RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9003
Practice Address - Country:US
Practice Address - Phone:717-372-6769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily