MEDICARE: DR. TRACI RICHARDS BURKS NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	1-070234	AL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	246516	AZ
3	363LF0000X	Family Nurse Practitioner	AP04593	LA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP04593	LA

General Provider Information

NPI Number	:	1528171899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACI RICHARDS BURKS NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	3341 YOUREE DR STE 20B
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2149
Country	:	US
Telephone Number	:	318-349-0722
Fax Number	:	318-335-4481

Provider Business Practice Location Address
First Line	:	3341 YOUREE DR STE 20B
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2149
Country	:	US
Telephone Number	:	318-553-1168
Fax Number	:	318-354-4811

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	05/30/2025

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