Provider Demographics
NPI:1730385451
Name:CHERRY BURKETT, MARILYN SUE (CRNP MSN CDE)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:SUE
Last Name:CHERRY BURKETT
Suffix:
Gender:F
Credentials:CRNP MSN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-794-1148
Mailing Address - Fax:334-793-1954
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-794-1148
Practice Address - Fax:334-793-1954
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1084300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51546056Medicare PIN