MEDICARE: LANDEN 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	390200000X	Student in an Organized Health Care Education/Training Program		OK

General Provider Information

NPI Number	:	1790617934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANDEN BURKE

Provider Business Mailing Address
First Line	:	405 S 3RD ST
Second Line	:
City	:	HARTSHORNE
State	:	OK
Zip	:	74547-4005
Country	:	US
Telephone Number	:	918-470-3362
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 W 17TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74107-1886
Country	:	US
Telephone Number	:	918-561-8257
Fax Number	:

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ LANDEN BURKE ” Practice Location

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