Provider Demographics
NPI:1326800715
Name:BURDICK, AMY
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:BURDICK
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 1:210 STARTING POINT DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-8308
Mailing Address - Country:US
Mailing Address - Phone:580-749-7322
Mailing Address - Fax:
Practice Address - Street 1:210 STARTING POINT DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-8308
Practice Address - Country:US
Practice Address - Phone:580-749-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist