Provider Demographics
NPI:1790971745
Name:BURNS, KARA LORI (LMT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LORI
Last Name:BURNS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26511 SW 4TH RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-4501
Mailing Address - Country:US
Mailing Address - Phone:352-514-1713
Mailing Address - Fax:
Practice Address - Street 1:2720 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2994
Practice Address - Country:US
Practice Address - Phone:352-514-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687942096Medicaid