Provider Demographics
NPI:1235120486
Name:BURKS, TERESA LYNN (NP, APN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:BURKS
Suffix:
Gender:F
Credentials:NP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5251 W CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1715
Mailing Address - Country:US
Mailing Address - Phone:623-547-5253
Mailing Address - Fax:623-533-6271
Practice Address - Street 1:5251 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1715
Practice Address - Country:US
Practice Address - Phone:623-547-5253
Practice Address - Fax:623-533-6271
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006576363LF0000X
AZAP7768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00842835OtherRAILROAD MEDICARE
ILP00842835OtherRAILROAD MEDICARE
ILP31977Medicare UPIN
ILP00842835OtherRAILROAD MEDICARE