MEDICARE: MELISSA BURKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	1407722705	ID
2	222Q00000X	Developmental Therapist
3	251S00000X	Community/Behavioral Health Agency	1407722705	ID
4	261QD1600X	Developmental Disabilities Clinic/Center	1407722705	ID

General Provider Information

NPI Number	:	1407722705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BURKE

Provider Business Mailing Address
First Line	:	2516 S BLUEGRASS DR
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-1381
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2516 S BLUEGRASS DR
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-1381
Country	:	US
Telephone Number	:	208-440-6809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	05/29/2026

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Directions to “ MELISSA BURKE ” Practice Location

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