Provider Demographics
NPI:1790461341
Name:BURT, AUSTIN JAMES
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:BURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 W 56TH ST APT C203
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4125
Mailing Address - Country:US
Mailing Address - Phone:919-627-2352
Mailing Address - Fax:
Practice Address - Street 1:1714 W 56TH ST APT C203
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4125
Practice Address - Country:US
Practice Address - Phone:919-627-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program