Healthcare Provider Details

I. General information

NPI: 1417682162
Provider Name (Legal Business Name): CARISSA BURKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SOUTH LN
MORELAND HILLS OH
44022-1145
US

IV. Provider business mailing address

115 SOUTH LN
MORELAND HILLS OH
44022-1145
US

V. Phone/Fax

Practice location:
  • Phone: 440-488-6724
  • Fax:
Mailing address:
  • Phone: 440-488-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: