Provider Demographics
NPI:1619977865
Name:BURKETT, KEVIN H (FNP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:H
Last Name:BURKETT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 N STATE HIGHWAY 123 STE A
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7848
Mailing Address - Country:US
Mailing Address - Phone:512-392-5556
Mailing Address - Fax:512-392-8828
Practice Address - Street 1:1348 N STATE HIGHWAY 123 STE A
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7848
Practice Address - Country:US
Practice Address - Phone:512-392-5556
Practice Address - Fax:512-392-8828
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660250363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169677501Medicaid
TX169677501Medicaid