Healthcare Provider Details

I. General information

NPI: 1306409768
Provider Name (Legal Business Name): ANNA WHALEY BURKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 N BALLAS RD STE 440
SAINT LOUIS MO
63131-2363
US

IV. Provider business mailing address

3023 N BALLAS RD STE 440
SAINT LOUIS MO
63131-2363
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-8181
  • Fax: 314-432-0090
Mailing address:
  • Phone: 314-432-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2009019252
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04190486
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: