Provider Demographics
NPI:1013465434
Name:BURKETT, MYISHA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MYISHA
Middle Name:
Last Name:BURKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 E 7TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4314
Mailing Address - Country:US
Mailing Address - Phone:704-332-7141
Mailing Address - Fax:704-342-3324
Practice Address - Street 1:2620 E 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4314
Practice Address - Country:US
Practice Address - Phone:704-332-7141
Practice Address - Fax:704-342-3324
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty