Provider Demographics
NPI:1528427788
Name:BURDEN, NEKISHA
Entity type:Individual
Prefix:
First Name:NEKISHA
Middle Name:
Last Name:BURDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 TURMAN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8998
Mailing Address - Country:US
Mailing Address - Phone:870-819-0249
Mailing Address - Fax:
Practice Address - Street 1:413 W TYLER AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4149
Practice Address - Country:US
Practice Address - Phone:870-733-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2018-07-10
Deactivation Date:2018-06-27
Deactivation Code:
Reactivation Date:2018-07-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator