Provider Demographics
NPI:1629253786
Name:BURKETT, CLARENCE ALLEN JR (NURSE)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:ALLEN
Last Name:BURKETT
Suffix:JR
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 827 BOX 306
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09617
Mailing Address - Country:IT
Mailing Address - Phone:01139081-811-6432
Mailing Address - Fax:
Practice Address - Street 1:PSC 827 BOX 1000
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09716
Practice Address - Country:IT
Practice Address - Phone:01139081-811-6381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001154496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse