Healthcare Provider Details

I. General information

NPI: 1518829084
Provider Name (Legal Business Name): EMILY DAWN BURKYBILE IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 PARK CIR
MIAMI OK
74354-4915
US

IV. Provider business mailing address

404 PARK CIR
MIAMI OK
74354-4915
US

V. Phone/Fax

Practice location:
  • Phone: 918-228-3672
  • Fax:
Mailing address:
  • Phone: 918-228-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-308863
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: