Provider Demographics
NPI:1902275480
Name:BURK, LISA A (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BURK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-4107
Mailing Address - Country:US
Mailing Address - Phone:843-248-0104
Mailing Address - Fax:
Practice Address - Street 1:1501 9TH AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4107
Practice Address - Country:US
Practice Address - Phone:843-248-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6279363LA2200X
SC26162363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health