Healthcare Provider Details

I. General information

NPI: 1417880667
Provider Name (Legal Business Name): AMBER DAWN BURDETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9408 E 117TH ST S
BIXBY OK
74008-1810
US

IV. Provider business mailing address

9408 E 117TH ST S
BIXBY OK
74008-1810
US

V. Phone/Fax

Practice location:
  • Phone: 918-527-6001
  • Fax:
Mailing address:
  • Phone: 918-527-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number228655
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: