Provider Demographics
NPI:1811008634
Name:BURKE, KATHLEEN (RNC,MS, NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:RNC,MS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MAIN ST 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-371-7010
Mailing Address - Fax:
Practice Address - Street 1:340 MAPLE ST 201
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-460-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165067363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMB03805471OtherSTATE CONTROLLED SUBSTANC
MA53313OtherFALLEN COMMUNITY HEALTH C
MANP1970OtherBC/BS
MANP1970OtherBC/BS
MANP1970Medicare ID - Type Unspecified