Healthcare Provider Details

I. General information

NPI: 1528427788
Provider Name (Legal Business Name): NEKISHA BURDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date: 06/27/2018
Reactivation Date: 07/10/2018

III. Provider practice location address

413 W TYLER AVE
WEST MEMPHIS AR
72301-4149
US

IV. Provider business mailing address

3012 TURMAN DR
JONESBORO AR
72404-8998
US

V. Phone/Fax

Practice location:
  • Phone: 870-733-1200
  • Fax:
Mailing address:
  • Phone: 870-819-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: