Provider Demographics
NPI:1629794318
Name:BURD, KADELYN LEIGH
Entity Type:Individual
Prefix:
First Name:KADELYN
Middle Name:LEIGH
Last Name:BURD
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 1:521 W LOTT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1642
Mailing Address - Country:US
Mailing Address - Phone:307-684-5531
Mailing Address - Fax:
Practice Address - Street 1:521 W LOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1642
Practice Address - Country:US
Practice Address - Phone:307-684-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY099175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist