Basic Information
| Provider Information | |||||||||
| NPI: | 1417036104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | ARNP, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1312 N 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747012810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809202069 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1312 N 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747012810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809202069 | ||||||||
| FaxNumber: | 8664042313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP115719 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | R0084153 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.