Provider Demographics
NPI:1477888105
Name:BURDIN, CHARRAE G (APRN)
Entity Type:Individual
Prefix:
First Name:CHARRAE
Middle Name:G
Last Name:BURDIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-0083
Mailing Address - Country:US
Mailing Address - Phone:870-857-3334
Mailing Address - Fax:870-857-9934
Practice Address - Street 1:1 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4017
Practice Address - Country:US
Practice Address - Phone:870-236-2000
Practice Address - Fax:870-236-5861
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03279 APN363LF0000X
ARA003279363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181104758Medicaid