Provider Demographics
NPI:1649715889
Name:BURROWS FAMILY CLINIC APRN-CNP PLLC
Entity type:Organization
Organization Name:BURROWS FAMILY CLINIC APRN-CNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERITY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:844-266-5385
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-0675
Mailing Address - Country:US
Mailing Address - Phone:844-266-5385
Mailing Address - Fax:844-266-5385
Practice Address - Street 1:417 E TAMARACK RD
Practice Address - Street 2:SUITE C
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1199
Practice Address - Country:US
Practice Address - Phone:844-266-5385
Practice Address - Fax:844-266-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK187271309261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1285977801Medicare PIN