Provider Demographics
NPI:1942021894
Name:BURKHART, ANGELA ELAINE
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ELAINE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 KAREN CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1124
Mailing Address - Country:US
Mailing Address - Phone:681-205-1465
Mailing Address - Fax:
Practice Address - Street 1:5411 KAREN CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1124
Practice Address - Country:US
Practice Address - Phone:681-205-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency