Healthcare Provider Details

I. General information

NPI: 1871446989
Provider Name (Legal Business Name): MAKYLA AMBREA BURKS COSMETOLOGIST/DME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 BECKLEY RD STE B
BATTLE CREEK MI
49015-4170
US

IV. Provider business mailing address

756 WATTLES RD N
BATTLE CREEK MI
49014-7811
US

V. Phone/Fax

Practice location:
  • Phone: 269-282-4061
  • Fax:
Mailing address:
  • Phone: 269-282-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2701450827
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: