Provider Demographics
NPI:1457982043
Name:BURKETT, ALICIA NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:NICOLE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 KING GEORGE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4514
Mailing Address - Country:US
Mailing Address - Phone:443-928-0322
Mailing Address - Fax:
Practice Address - Street 1:125 KING GEORGE WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4514
Practice Address - Country:US
Practice Address - Phone:443-928-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC243735163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical