Provider Demographics
NPI:1255600722
Name:BURKS, MARY H (RD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:BURKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 DEVONSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1268
Mailing Address - Country:US
Mailing Address - Phone:304-920-2767
Mailing Address - Fax:
Practice Address - Street 1:150 COURTHOUSE RD STE 301-B
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2450
Practice Address - Country:US
Practice Address - Phone:304-425-0162
Practice Address - Fax:304-425-0163
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV726-136133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal