Provider Demographics
NPI:1730115569
Name:BURKHARDT, BRIAN RUSCHMAN (ARNP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RUSCHMAN
Last Name:BURKHARDT
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636324
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6324
Mailing Address - Country:US
Mailing Address - Phone:859-301-9010
Mailing Address - Fax:859-301-9018
Practice Address - Street 1:711 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-301-9010
Practice Address - Fax:859-301-9018
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004382363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013000Medicaid
OH3037672Medicaid
KY00954006Medicare PIN
0658608Medicare PIN
KY78013000Medicaid
6586Medicare PIN