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Individual
MR. JOHN W. BURCKLE
Active
Individual
MR. JOHN W. BURCKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1227
TN
363A00000X
Physician Assistant
Primary
PA1008
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3663192
—
TN
01
—
4097067
BLUE CROSS
TN
05
—
7100011930
—
KY
Enumeration date
06/14/2006
Last updated
02/22/2024
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