Healthcare Provider Details

I. General information

NPI: 1699159988
Provider Name (Legal Business Name): WHITNEY MARIE BURK RN, BSN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WHITNEY MARIE INGRAM APRN CNP

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S UTICA AVE STE A
TULSA OK
74104-5346
US

IV. Provider business mailing address

PO BOX 315
CHOUTEAU OK
74337-0315
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-1300
  • Fax: 918-403-0383
Mailing address:
  • Phone: 918-476-6030
  • Fax: 918-476-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004552
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102281
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: