Healthcare Provider Details

I. General information

NPI: 1053304626
Provider Name (Legal Business Name): NATALIE KAREN BURKS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLOW CREEK PKWY SUITE C
PALESTINE TX
75801-4383
US

IV. Provider business mailing address

PO BOX 817
PALESTINE TX
75802-0817
US

V. Phone/Fax

Practice location:
  • Phone: 903-723-8210
  • Fax: 903-723-8310
Mailing address:
  • Phone: 903-727-0110
  • Fax: 903-727-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number250616
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: