Provider Demographics
NPI:1710642350
Name:BURKEEN, MARY SUSAN (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:BURKEEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY SUSAN
Other - Middle Name:
Other - Last Name:BURKEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:225 MEDICAL CENTER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7934
Mailing Address - Country:US
Mailing Address - Phone:270-441-4357
Mailing Address - Fax:270-441-4132
Practice Address - Street 1:225 MEDICAL CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7934
Practice Address - Country:US
Practice Address - Phone:270-441-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016978363LF0000X
TN32446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily