Healthcare Provider Details

I. General information

NPI: 1609531383
Provider Name (Legal Business Name): PAYTON EVAN BURKE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 3030 CAMP HUMPHREYS
APO AP
96271
US

IV. Provider business mailing address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-2833
  • Fax:
Mailing address:
  • Phone: 253-968-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006781
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: