Provider Demographics
NPI:1952955023
Name:DEBURGO, KANEISHA RAE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KANEISHA
Middle Name:RAE
Last Name:DEBURGO
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OLD SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-1866
Mailing Address - Country:US
Mailing Address - Phone:508-824-7557
Mailing Address - Fax:
Practice Address - Street 1:600 OLD SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764-1866
Practice Address - Country:US
Practice Address - Phone:508-824-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02687363LP2300X
MARN2280848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care