MEDICARE: KASEY GOODMAN BURKS APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP10105	LA

General Provider Information

NPI Number	:	1437634789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY GOODMAN BURKS APRN, FNP-C

Provider Business Mailing Address
First Line	:	617 N 2ND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-6235
Country	:	US
Telephone Number	:	318-366-5464
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 N 2ND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5837
Country	:	US
Telephone Number	:	318-388-2050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	10/02/2018

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