Provider Demographics
NPI:1295799310
Name:BURKE, JAMES KENNEDY (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNEDY
Last Name:BURKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:PAYNEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40157
Mailing Address - Country:US
Mailing Address - Phone:270-351-5505
Mailing Address - Fax:270-351-5504
Practice Address - Street 1:257 WATSON RD
Practice Address - Street 2:
Practice Address - City:PAYNEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40157
Practice Address - Country:US
Practice Address - Phone:270-497-4840
Practice Address - Fax:270-497-4841
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611203585Medicare UPIN
KY3007604Medicare ID - Type Unspecified
KY00201007Medicare PIN
KY00205005Medicare PIN