Provider Demographics
NPI:1528171899
Name:BURKS, TRACI RICHARDS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:RICHARDS
Last Name:BURKS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 YOUREE DR STE 20B
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2149
Mailing Address - Country:US
Mailing Address - Phone:318-349-0722
Mailing Address - Fax:318-335-4481
Practice Address - Street 1:3341 YOUREE DR STE 20B
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2149
Practice Address - Country:US
Practice Address - Phone:318-553-1168
Practice Address - Fax:318-354-4811
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-070234363L00000X
AZ246516363LP0808X
LAAP04593363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily