Provider Demographics
NPI:1417520784
Name:BURTON, JALIK R (CNA)
Entity Type:Individual
Prefix:
First Name:JALIK
Middle Name:R
Last Name:BURTON
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11331 PARRISH CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3183
Mailing Address - Country:US
Mailing Address - Phone:804-662-0940
Mailing Address - Fax:
Practice Address - Street 1:2400 OLD BRICK RD STE 62
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5841
Practice Address - Country:US
Practice Address - Phone:804-223-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401167246376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide