Provider Demographics
NPI:1497883169
Name:BURKE, DOROTHY DEETTE (ARNP/BC)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:DEETTE
Last Name:BURKE
Suffix:
Gender:F
Credentials:ARNP/BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 ECHO LN
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2602
Mailing Address - Country:US
Mailing Address - Phone:931-308-2658
Mailing Address - Fax:765-450-8060
Practice Address - Street 1:957 ECHO LN
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2602
Practice Address - Country:US
Practice Address - Phone:931-308-2658
Practice Address - Fax:765-450-8060
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12062363LP0808X
VA0024176087363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health