Provider Demographics
NPI:1639515695
Name:BURDETTE, KATHY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 KEOWEE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-0523
Mailing Address - Country:US
Mailing Address - Phone:864-886-4475
Mailing Address - Fax:864-886-4474
Practice Address - Street 1:7051 KEOWEE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-0523
Practice Address - Country:US
Practice Address - Phone:864-886-4475
Practice Address - Fax:864-886-4474
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse