Provider Demographics
NPI:1043490816
Name:BURKHALTER, SUE M (CFNP)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:M
Last Name:BURKHALTER
Suffix:
Gender:
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3955
Mailing Address - Country:US
Mailing Address - Phone:018-702-3306
Mailing Address - Fax:
Practice Address - Street 1:3200 S KINGS HWY
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-5355
Practice Address - Country:US
Practice Address - Phone:918-225-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR749475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR749475OtherMS BOARD OF NURSING