Provider Demographics
NPI:1922583863
Name:BURKE, SAMANTHA LYNN
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 J JOINER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLETOWN
Mailing Address - State:OK
Mailing Address - Zip Code:74734-5207
Mailing Address - Country:US
Mailing Address - Phone:580-236-9625
Mailing Address - Fax:
Practice Address - Street 1:411 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6059
Practice Address - Country:US
Practice Address - Phone:580-286-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator