Provider Demographics
NPI:1366043515
Name:BURDETTE, PATRICIA (AGENCY OWNER)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BURDETTE
Suffix:
Gender:F
Credentials:AGENCY OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 GERTRUDE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-5753
Mailing Address - Country:US
Mailing Address - Phone:901-503-8845
Mailing Address - Fax:
Practice Address - Street 1:4955 GERTRUDE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-5753
Practice Address - Country:US
Practice Address - Phone:901-503-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel