Provider Demographics
NPI:1982031514
Name:BURKE, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
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 1:9914 I-30
Mailing Address - Street 2:DAYSPRING BEHAVIORAL HEALTH SYSTEM
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-8501
Mailing Address - Country:US
Mailing Address - Phone:501-565-8501
Mailing Address - Fax:501-565-1219
Practice Address - Street 1:9914 INTERSTATE 30
Practice Address - Street 2:DAYSPRING BEHAVIORAL HEALTH SYSTEM
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4201
Practice Address - Country:US
Practice Address - Phone:501-565-8501
Practice Address - Fax:501-565-1219
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004306364SP0810X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1982031514Medicaid