Provider Demographics
NPI:1770957300
Name:BURKS, KIM (NP)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1500 FOREST GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1460
Mailing Address - Country:US
Mailing Address - Phone:301-557-1146
Mailing Address - Fax:301-557-1119
Practice Address - Street 1:1500 FOREST GLEN RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1460
Practice Address - Country:US
Practice Address - Phone:301-557-1146
Practice Address - Fax:301-557-1119
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR147602363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health