Provider Demographics
NPI:1184499477
Name:BURDO, KIMBERLY M
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:BURDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 STERNWHEEL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1040
Mailing Address - Country:US
Mailing Address - Phone:636-448-9347
Mailing Address - Fax:636-549-8003
Practice Address - Street 1:87 STERNWHEEL CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-1040
Practice Address - Country:US
Practice Address - Phone:636-448-9347
Practice Address - Fax:636-549-8003
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator