Healthcare Provider Details

I. General information

NPI: 1770085474
Provider Name (Legal Business Name): MRS. DEBRA FAYE BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

IV. Provider business mailing address

2617 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

V. Phone/Fax

Practice location:
  • Phone: 405-858-2700
  • Fax:
Mailing address:
  • Phone: 405-858-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number74367
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: