Provider Demographics
NPI:1235637893
Name:BURGESS, RACHEL LAUREN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LAUREN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E TERRI DR
Mailing Address - Street 2:
Mailing Address - City:VALLIANT
Mailing Address - State:OK
Mailing Address - Zip Code:74764-6801
Mailing Address - Country:US
Mailing Address - Phone:580-933-9024
Mailing Address - Fax:580-933-9027
Practice Address - Street 1:508 E WILSON ST
Practice Address - Street 2:
Practice Address - City:VALLIANT
Practice Address - State:OK
Practice Address - Zip Code:74764-9115
Practice Address - Country:US
Practice Address - Phone:580-933-9025
Practice Address - Fax:833-382-0111
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily