Healthcare Provider Details

I. General information

NPI: 1376646646
Provider Name (Legal Business Name): PATSY J BURKS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 BUFFALO RD
LAWRENCEBURG TN
38464-2420
US

IV. Provider business mailing address

PO BOX 647
LAWRENCEBURG TN
38464-0647
US

V. Phone/Fax

Practice location:
  • Phone: 931-766-0433
  • Fax: 931-766-5021
Mailing address:
  • Phone: 931-766-0433
  • Fax: 931-766-5021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5192
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: