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General NPI Number Information
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NPI Number | 1407312598
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Entity Type | Individual
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Provider Name | MADISON ASHLEY BURKS PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 2300 ANDOVER CT
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City | LITTLE ROCK
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State | AR
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Zip | 72227-3987
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Country | US
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Telephone | 501-904-5159
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 DULLES DR
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City | LAFAYETTE
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State | LA
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Zip | 70506-3718
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Country | US
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Telephone | 337-991-9276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-901
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License Number State | AR
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