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General NPI Number Information
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NPI Number | 1477198927
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Entity Type | Individual
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Provider Name | JEFFREY E BURKETT
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Gender | Male
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 710 15TH ST E
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City | TUSCALOOSA
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State | AL
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Zip | 35401-3236
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Country | US
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Telephone | 205-509-2941
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Fax |
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Provider Business Mailing Address
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Address Line | 405 BELCHER ST
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City | CENTREVILLE
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State | AL
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Zip | 35042-2946
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Country | US
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Telephone | 205-926-2992
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-147352
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License Number State | AL
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