Healthcare Provider Details

I. General information

NPI: 1124635388
Provider Name (Legal Business Name): BRITTNEY SHERRELL BURKS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10314 BRIAR HOLLOW DR APT 7
SAINT LOUIS MO
63146-5777
US

IV. Provider business mailing address

10314 BRIAR HOLLOW DR APT 7
SAINT LOUIS MO
63146-5777
US

V. Phone/Fax

Practice location:
  • Phone: 314-210-1777
  • Fax:
Mailing address:
  • Phone: 314-210-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020019155
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: