Provider Demographics
NPI:1982393443
Name:BURKHART, TARYN ANN (PA)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:ANN
Last Name:BURKHART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31387 TOWNSHIP ROAD 55
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43754-9535
Mailing Address - Country:US
Mailing Address - Phone:740-213-7682
Mailing Address - Fax:
Practice Address - Street 1:955 BETHESDA DR FL 1
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1840
Practice Address - Country:US
Practice Address - Phone:740-454-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant