Provider Demographics
NPI:1275071607
Name:BURKE, CORAL NICOLE
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:NICOLE
Last Name:BURKE
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 1:1806 KATHLEEN ST
Mailing Address - Street 2:APT. B
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-9104
Mailing Address - Country:US
Mailing Address - Phone:870-819-8407
Mailing Address - Fax:
Practice Address - Street 1:1806 KATHLEEN ST
Practice Address - Street 2:APT. B
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-9104
Practice Address - Country:US
Practice Address - Phone:870-819-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator