Healthcare Provider Details

I. General information

NPI: 1104762129
Provider Name (Legal Business Name): SIDNE BURKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 INDEPENDENCE AVE
KENNETT MO
63857-1314
US

IV. Provider business mailing address

1417 GUNNER REED RD
KENNETT MO
63857-8391
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-5892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026016933
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: