Provider Demographics
NPI:1699064535
Name:BURLESON, RACHELLE LYNN (CCNS, APRN)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LYNN
Last Name:BURLESON
Suffix:
Gender:F
Credentials:CCNS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W. WILLOW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703
Mailing Address - Country:US
Mailing Address - Phone:580-242-5800
Mailing Address - Fax:580-242-5881
Practice Address - Street 1:1218 W WILLOW RD
Practice Address - Street 2:SUITE A
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2533
Practice Address - Country:US
Practice Address - Phone:580-242-5800
Practice Address - Fax:580-242-5881
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88871364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care