1447331335 NPI number — SHERRI A BURKE DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447331335 NPI number — SHERRI A BURKE DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BURKE

Provider First Name:

SHERRI

Provider Middle Name:

A

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1447331335

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/14/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 99371

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FORT WORTH

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

76199-0371

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

682-885-1855

Provider Business Mailing Address Fax Number:

682-885-7347

Provider First Line Business Practice Location Address:

3200 RIVERFRONT DR

Provider Second Line Business Practice Location Address:

STE103

Provider Business Practice Location Address City Name:

FORT WORTH

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

76107-6570

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

817-336-3800

Provider Business Practice Location Address Fax Number:

817-335-9454

Provider Enumeration Date:

10/18/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  H8994 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2110723 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: BURSF34697 . This is a "CCHIP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 102244406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 135879100 . This is a "FIRSTCARE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 4235136 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 5558301 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 1014718 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 1750369203 . This is a "GRP NPI NUMBER" identifier . This identifiers is of the category "OTHER".
• Identifier: 8G0312 . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 00U87Z . This is a "BCBSTX GRP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 102244407 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".