Individual
CHARITY JOY BURKHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3065 W SOUTHLAKE BLVD # 140, SOUTHLAKE, TX 76092-6730
(817) 380-5911
(817) 385-6579
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA08610
STATE LICENSE NUMBER
TX
01
—
S0201078
DPS CERTIFICATE NUMBER
TX
Enumeration date
05/21/2013
Last updated
08/29/2024
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