Provider Demographics
NPI:1932662376
Name:BURKHEAD, KEVIN W
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:BURKHEAD
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 1:3780 HIRST CIR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5572
Mailing Address - Country:US
Mailing Address - Phone:419-651-8508
Mailing Address - Fax:
Practice Address - Street 1:4406 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-4305
Practice Address - Country:US
Practice Address - Phone:865-525-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist