Provider Demographics
NPI:1447633565
Name:BURKS, KATRINA (NP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:784 HERCULES DR STE 110
Mailing Address - Street 2:ATTN CREDENTIALING/RAYCHEL NELSON
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8049
Mailing Address - Country:US
Mailing Address - Phone:802-448-9787
Mailing Address - Fax:802-448-9787
Practice Address - Street 1:173 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4636
Practice Address - Country:US
Practice Address - Phone:866-476-1321
Practice Address - Fax:802-863-4951
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2023-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH084296-23363LF0000X
MECNP201517363LF0000X
VT101.0109464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3126540Medicaid
VT1025621Medicaid