Provider Demographics
NPI:1487650750
Name:BURKS, PATRICIA ANNE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:BURKS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S LOUIS TITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-4406
Mailing Address - Country:US
Mailing Address - Phone:580-782-3393
Mailing Address - Fax:580-782-3395
Practice Address - Street 1:114 S LOUIS TITTLE AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-4406
Practice Address - Country:US
Practice Address - Phone:580-782-3393
Practice Address - Fax:580-782-3395
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR48747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100214940BMedicaid
OK100214940BMedicaid
OKOKAAA3265Medicare PIN
OKS48401Medicare UPIN