Healthcare Provider Details

I. General information

NPI: 1104846112
Provider Name (Legal Business Name): CYNTHIA LONIGAN BURKES P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTH JOHNSON STREET
COATS NC
27521
US

IV. Provider business mailing address

PO BOX 819
COATS NC
27521-0819
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-6423
  • Fax: 910-897-2540
Mailing address:
  • Phone: 910-897-6423
  • Fax: 910-897-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number102972
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: