Provider Demographics
NPI:1720584535
Name:BURKS, THERESA YVETTE (LVN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:YVETTE
Last Name:BURKS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4965
Mailing Address - Country:US
Mailing Address - Phone:618-420-3861
Mailing Address - Fax:
Practice Address - Street 1:4018 DAVID DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4965
Practice Address - Country:US
Practice Address - Phone:618-420-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167241164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse