Provider Demographics
NPI:1962003863
Name:BURNS, KRISTEN DICKERSON (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DICKERSON
Last Name:BURNS
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:KARNACK
Mailing Address - State:TX
Mailing Address - Zip Code:75661-1893
Mailing Address - Country:US
Mailing Address - Phone:903-720-8136
Mailing Address - Fax:
Practice Address - Street 1:2530 BERT KOUNS INDUSTRIAL LOOP STE 138
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-6114
Practice Address - Country:US
Practice Address - Phone:318-212-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA216092363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health