Healthcare Provider Details

I. General information

NPI: 1063815546
Provider Name (Legal Business Name): BART BURDICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 NW 132ND ST
OKLAHOMA CITY OK
73142-4437
US

IV. Provider business mailing address

5721 NW 132ND ST
OKLAHOMA CITY OK
73142-4437
US

V. Phone/Fax

Practice location:
  • Phone: 405-557-1200
  • Fax: 405-557-1977
Mailing address:
  • Phone: 405-557-1200
  • Fax: 405-557-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95466
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: