Provider Demographics
NPI:1225780885
Name:BURKETT, ELIZABETH MAE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MAE
Other - Last Name:HAGGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10600 SILVER SPUR DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89508-8117
Mailing Address - Country:US
Mailing Address - Phone:706-604-4604
Mailing Address - Fax:
Practice Address - Street 1:897 IRONWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-5198
Practice Address - Country:US
Practice Address - Phone:775-782-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant