Healthcare Provider Details

I. General information

NPI: 1669278354
Provider Name (Legal Business Name): JESTYNE BURK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GOLIAD RD LOT 138
SAN ANTONIO TX
78223-4360
US

IV. Provider business mailing address

3500 GOLIAD RD LOT 138
SAN ANTONIO TX
78223-4360
US

V. Phone/Fax

Practice location:
  • Phone: 830-477-9666
  • Fax:
Mailing address:
  • Phone: 830-477-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1213625
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number983428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: