Provider Demographics
NPI:1386746600
Name:BURKE, BARBARA JEAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:BARBARA
Middle Name:JEAN
Last Name:BURKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5831
Mailing Address - Country:US
Mailing Address - Phone:406-549-9808
Mailing Address - Fax:
Practice Address - Street 1:303 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2405
Practice Address - Country:US
Practice Address - Phone:406-363-5056
Practice Address - Fax:406-363-5076
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTS4227Medicare UPIN