Provider Demographics
NPI:1699159988
Name:BURK, WHITNEY MARIE (RN, BSN, MSN)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:MARIE
Last Name:BURK
Suffix:
Gender:F
Credentials:RN, BSN, MSN
Other - Prefix:MS
Other - First Name:WHITNEY
Other - Middle Name:MARIE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN CNP
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337-0315
Mailing Address - Country:US
Mailing Address - Phone:918-476-6030
Mailing Address - Fax:918-476-6038
Practice Address - Street 1:1717 S UTICA AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5346
Practice Address - Country:US
Practice Address - Phone:918-748-1300
Practice Address - Fax:918-403-0383
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004552363LF0000X
OK102281363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200608500AMedicaid