Organization
FOREVER KIDS PEDIATRIC CLINIC
Active
Organization
FOREVER KIDS PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LACY DAWN BURKES RN , CPNP-PC (PEDIATRIC NURSE PRACTITIONER)
(214) 773-5669
Entity
Organization
Contact information
Practice address
20783 INTERSTATE 20 SOUTH ACCESS ROAD, CANTON, TX 75103
(214) 773-5669
(844) 678-6258
Mailing address
20783 INTERSTATE 20 SOUTH ACCESS ROAD, CANTON, TX 75103
(903) 567-5437
(844) 678-6258
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
754047
TX
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1349815603
—
TX
01
—
1750646279
NPI
TX
Enumeration date
04/20/2015
Last updated
01/26/2023
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