Provider Demographics
NPI:1639154677
Name:BURDETT, LINDA C (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:BURDETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 S CAMPBELL AVE STE T-1
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4980
Mailing Address - Country:US
Mailing Address - Phone:417-220-4480
Mailing Address - Fax:417-900-2992
Practice Address - Street 1:3322 S CAMPBELL AVE STE T-1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4980
Practice Address - Country:US
Practice Address - Phone:417-220-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002009459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425812104Medicaid
P00269596OtherRR MEDICARE
MO1639154677Medicaid
MOMA1327061Medicare PIN
056050115Medicare ID - Type Unspecified
MO501150022Medicare PIN
P00515Medicare UPIN
MO425812104Medicaid