Provider Demographics
NPI:1528068772
Name:BURKETT, SHIRLEY KATHERINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:KATHERINE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:KATHERINE
Other - Last Name:BURKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:9 GREENWAY PLZ
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 SOUTH FM 1626
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-0000
Practice Address - Country:US
Practice Address - Phone:512-268-1940
Practice Address - Fax:512-268-5186
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N7088OtherBLUE CROSS BLUE SHIELD
TX8Y4029OtherBCBS PVN
TX167232102Medicaid
TX8L14199Medicare PIN
TX8Y4029OtherBCBS PVN
TX8F6058Medicare PIN
TXP79498Medicare UPIN
TX8L14198Medicare PIN