Provider Demographics
NPI:1821169590
Name:BURKHART-GORDON, MARY CATHERINE (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:BURKHART-GORDON
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:BURKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2451 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2471
Mailing Address - Country:US
Mailing Address - Phone:480-494-2770
Mailing Address - Fax:480-494-2771
Practice Address - Street 1:4105 BRIARGATE PKWY STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3484
Practice Address - Country:US
Practice Address - Phone:719-886-6704
Practice Address - Fax:877-550-2140
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207906363L00000X
AZAP4675363L00000X, 363L00000X
COC-APN.0103531-C-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ757385Medicaid
AZP01137754OtherRAILROAD MEDICARE
FL002828500Medicaid
10001631801OtherCHP PROVIDER NUMBER
MO427250709Medicaid
500028442OtherRR MEDICARE
511800OtherFIRSTGUARD
481202402OtherPSKU TAX ID
AZ757385Medicaid
KS100446630AMedicaid
MO427250709Medicaid
511800OtherFIRSTGUARD
6544OtherPHS PROVIDER NUMBER
AZZ93290Medicare PIN