Individual
KELLY GILTHORPE BURKENSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6600 FLEUR DE LIS DR, NEW ORLEANS, LA 70124-1430
(504) 888-2829
(504) 888-7439
Mailing address
2040 N CAUSEWAY BLVD, MANDEVILLE, LA 70471
(985) 727-7676
(985) 727-3476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
023319
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1496278
—
LA
Enumeration date
06/13/2005
Last updated
07/19/2022
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