Provider Demographics
NPI:1609652338
Name:BURKE, KRISHONNA RAMIA (CPT, CCMA)
Entity Type:Individual
Prefix:
First Name:KRISHONNA
Middle Name:RAMIA
Last Name:BURKE
Suffix:
Gender:F
Credentials:CPT, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 ROBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1637
Mailing Address - Country:US
Mailing Address - Phone:866-547-5227
Mailing Address - Fax:985-217-1578
Practice Address - Street 1:753 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1637
Practice Address - Country:US
Practice Address - Phone:866-547-5227
Practice Address - Fax:985-217-1578
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA328805246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy