Healthcare Provider Details

I. General information

NPI: 1982966867
Provider Name (Legal Business Name): MAX ANDREW BURKETT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3287 MALCOLM DR
MONTGOMERY AL
36116-8816
US

IV. Provider business mailing address

3287 MALCOLM DR
MONTGOMERY AL
36116-8816
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-9970
  • Fax: 334-356-9873
Mailing address:
  • Phone: 334-356-9970
  • Fax: 334-356-9873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-054443
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: