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NPI Code Detail

MEDICARE: MRS. NICOLE ALYSON BURKS

MEDICARE: MRS. NICOLE ALYSON BURKS
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1972200749
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE ALYSON BURKS
Provider Business Mailing Address
First Line : 1227 CHESTNUT ST
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-9661
Country : US
Telephone Number : 540-878-1354
Fax Number :
Provider Business Practice Location Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1398
Country : US
Telephone Number : 304-766-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2023
Last Update Date : 02/13/2023

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Directions to “ MRS. NICOLE ALYSON BURKS ” Practice Location

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