Provider Demographics
NPI:1124397005
Name:BURKS, DEMARCUS (MHPP)
Entity Type:Individual
Prefix:MR
First Name:DEMARCUS
Middle Name:
Last Name:BURKS
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 CALVIN AVERY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-6501
Mailing Address - Country:US
Mailing Address - Phone:870-732-1878
Mailing Address - Fax:870-702-7111
Practice Address - Street 1:304 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HUGHES
Practice Address - State:AR
Practice Address - Zip Code:72348-9700
Practice Address - Country:US
Practice Address - Phone:870-339-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator