Healthcare Provider Details

I. General information

NPI: 1407722705
Provider Name (Legal Business Name): MELISSA BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 S BLUEGRASS DR
NAMPA ID
83686-1381
US

IV. Provider business mailing address

2516 S BLUEGRASS DR
NAMPA ID
83686-1381
US

V. Phone/Fax

Practice location:
  • Phone: 208-440-6809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1407722705
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1407722705
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number1407722705
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: