Basic Information
| Provider Information | |||||||||
| NPI: | 1982966867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKETT | ||||||||
| FirstName: | MAX | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3287 MALCOLM DR | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361168816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343569970 | ||||||||
| FaxNumber: | 3343569873 | ||||||||
| Practice Location | |||||||||
| Address1: | 3287 MALCOLM DR | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361168816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343569970 | ||||||||
| FaxNumber: | 3343569873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2012 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1-054443 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.