Provider Demographics
NPI:1548253776
Name:BURKE, JOANNA (PNP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ROCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ROCK PORT
Mailing Address - State:MO
Mailing Address - Zip Code:64482-1172
Mailing Address - Country:US
Mailing Address - Phone:660-744-5781
Mailing Address - Fax:
Practice Address - Street 1:100 E CASS ST
Practice Address - Street 2:
Practice Address - City:ROCK PORT
Practice Address - State:MO
Practice Address - Zip Code:64482-1528
Practice Address - Country:US
Practice Address - Phone:660-744-5361
Practice Address - Fax:660-744-2247
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149258363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics