Healthcare Provider Details

I. General information

NPI: 1497883169
Provider Name (Legal Business Name): DOROTHY DEETTE BURKE ARNP/BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 ECHO LN
KOKOMO IN
46902-2602
US

IV. Provider business mailing address

957 ECHO LN
KOKOMO IN
46902-2602
US

V. Phone/Fax

Practice location:
  • Phone: 931-308-2658
  • Fax: 765-450-8060
Mailing address:
  • Phone: 931-308-2658
  • Fax: 765-450-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71016469A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN12062
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024176087
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: