Provider Demographics
NPI:1245569300
Name:BURKS, BESSIE ELIZABETH (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:BESSIE
Middle Name:ELIZABETH
Last Name:BURKS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 NORTH T
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436
Mailing Address - Country:US
Mailing Address - Phone:805-865-1940
Mailing Address - Fax:805-865-1951
Practice Address - Street 1:646 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-4519
Practice Address - Country:US
Practice Address - Phone:805-865-1940
Practice Address - Fax:805-865-1951
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760178163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult