Provider Demographics
NPI:1730871310
Name:BURKS, ANDREA DEE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DEE
Last Name:BURKS
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 1:30600 MCCONNELL RD
Mailing Address - Street 2:
Mailing Address - City:WANETTE
Mailing Address - State:OK
Mailing Address - Zip Code:74878-5523
Mailing Address - Country:US
Mailing Address - Phone:580-210-8109
Mailing Address - Fax:
Practice Address - Street 1:30600 MCCONNELL RD
Practice Address - Street 2:
Practice Address - City:WANETTE
Practice Address - State:OK
Practice Address - Zip Code:74878-5523
Practice Address - Country:US
Practice Address - Phone:580-210-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist