Healthcare Provider Details

I. General information

NPI: 1548916489
Provider Name (Legal Business Name): JACKLYNN M BURK MSN, FPMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKLYNN M HEISLER

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17844 E 23RD ST S
INDEPENDENCE MO
64057-1840
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 816-254-3652
  • Fax:
Mailing address:
  • Phone: 417-761-5000
  • Fax: 417-761-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022006456
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: