Provider Demographics
NPI:1033957311
Name:BURKE, MAKENNA GRACE (FNP)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:GRACE
Last Name:BURKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAKENNA
Other - Middle Name:GRACE
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 THRASHER CV
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3415
Mailing Address - Country:US
Mailing Address - Phone:408-821-3806
Mailing Address - Fax:
Practice Address - Street 1:651 N HIGHWAY 183 STE 110
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-7002
Practice Address - Country:US
Practice Address - Phone:512-528-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily