Healthcare Provider Details

I. General information

NPI: 1427514538
Provider Name (Legal Business Name): KIRSTEN PETERSON BURKS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 COUNTRY CLUB DR
MOUNTAIN HOME AR
72653-4102
US

IV. Provider business mailing address

301 COUNTRY CLUB DR
MOUNTAIN HOME AR
72653-4102
US

V. Phone/Fax

Practice location:
  • Phone: 870-736-2601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005620
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: