Provider Demographics
NPI:1538368667
Name:PATSY J BURKS
Entity type:Organization
Organization Name:PATSY J BURKS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:931-766-5239
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0647
Mailing Address - Country:US
Mailing Address - Phone:931-766-5239
Mailing Address - Fax:931-766-5021
Practice Address - Street 1:609 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2420
Practice Address - Country:US
Practice Address - Phone:931-766-5239
Practice Address - Fax:931-766-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374553Medicare PIN