Provider Demographics
NPI:1689723785
Name:BURKLE, LYLE C (MS APRN)
Entity Type:Individual
Prefix:MR
First Name:LYLE
Middle Name:C
Last Name:BURKLE
Suffix:
Gender:M
Credentials:MS APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 RAVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-1744
Mailing Address - Country:US
Mailing Address - Phone:402-995-5795
Mailing Address - Fax:
Practice Address - Street 1:4101 WOOLWORTH AVE BLDG 8
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1850
Practice Address - Country:US
Practice Address - Phone:402-995-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE33966163WP0809X
NE114009364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult