Provider Demographics
NPI:1033728266
Name:BURKETT, CODY (RN)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BURKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 KANIS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3794
Mailing Address - Country:US
Mailing Address - Phone:501-221-1941
Mailing Address - Fax:
Practice Address - Street 1:11700 KANIS RD STE 2
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3794
Practice Address - Country:US
Practice Address - Phone:501-221-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR106295163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult