Healthcare Provider Details

I. General information

NPI: 1538368667
Provider Name (Legal Business Name): PATSY J BURKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 01/07/2013
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: 931-766-5239
  • Fax: 931-766-5021
Mailing address:
  • Phone: 931-766-5239
  • 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: MRS. PATSY J BURKS
Title or Position: OWNER
Credential: APN
Phone: 931-766-5239