Provider Demographics
NPI:1770657868
Name:BURKE, TIMOTHY N (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:N
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WALNUT ST STE 209
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-2956
Mailing Address - Country:US
Mailing Address - Phone:270-689-6690
Mailing Address - Fax:270-689-6747
Practice Address - Street 1:1100 WALNUT ST STE 209
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2956
Practice Address - Country:US
Practice Address - Phone:270-689-6690
Practice Address - Fax:270-689-6747
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY203422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64203425Medicaid
KY64203425Medicaid
KYC74532Medicare UPIN