Provider Demographics
NPI:1013793694
Name:BURKET, ALEXIS GRACE (CNP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GRACE
Last Name:BURKET
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 E BROME PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5447
Mailing Address - Country:US
Mailing Address - Phone:605-641-1271
Mailing Address - Fax:
Practice Address - Street 1:1216 RYANS RD STE 3
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1781
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2474922363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health