Healthcare Provider Details

I. General information

NPI: 1215073598
Provider Name (Legal Business Name): MS. AMY LYN BURKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 W MARCH LN SUITE 125
STOCKTON CA
95207-8251
US

IV. Provider business mailing address

2495 W MARCH LN
STOCKTON CA
95207-8251
US

V. Phone/Fax

Practice location:
  • Phone: 209-465-1080
  • Fax:
Mailing address:
  • Phone: 209-465-1080
  • Fax: 209-465-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: