Provider Demographics
NPI:1861685570
Name:BURKS, ROSLYN DENISE (APN)
Entity Type:Individual
Prefix:MRS
First Name:ROSLYN
Middle Name:DENISE
Last Name:BURKS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ROSLYN
Other - Middle Name:
Other - Last Name:BURKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:1302 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5244
Mailing Address - Country:US
Mailing Address - Phone:870-413-9393
Mailing Address - Fax:
Practice Address - Street 1:4747 DUSTY LAKE DR
Practice Address - Street 2:SUITE G-1
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-8742
Practice Address - Country:US
Practice Address - Phone:870-536-6600
Practice Address - Fax:870-541-8623
Is Sole Proprietor?:No
Enumeration Date:2007-08-26
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03032ANP363LF0000X
ARA03032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily