Provider Demographics
NPI:1043784721
Name:BURKS, EVELYN DORIS (SOLE PROPRIETOR)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:DORIS
Last Name:BURKS
Suffix:
Gender:F
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 OAK LEAF DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3151
Mailing Address - Country:US
Mailing Address - Phone:972-977-7756
Mailing Address - Fax:
Practice Address - Street 1:411 OAK LEAF DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3151
Practice Address - Country:US
Practice Address - Phone:972-977-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor