Provider Demographics
NPI:1215202296
Name:BURLESON, CYNTHIA
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:BURLESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 S HOPE WELL RD
Mailing Address - Street 2:
Mailing Address - City:KENEFIC
Mailing Address - State:OK
Mailing Address - Zip Code:74748-8109
Mailing Address - Country:US
Mailing Address - Phone:580-916-5966
Mailing Address - Fax:
Practice Address - Street 1:301 FRENCH RD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-1000
Practice Address - Country:US
Practice Address - Phone:918-452-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator