Provider Demographics
NPI:1033127477
Name:BURGESS-PARKER, MARY ELLEN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:BURGESS-PARKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W MEIGHAN BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-3210
Mailing Address - Country:US
Mailing Address - Phone:256-467-4731
Mailing Address - Fax:256-467-4734
Practice Address - Street 1:1401 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5319
Practice Address - Country:US
Practice Address - Phone:256-543-9497
Practice Address - Fax:256-543-1343
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1073481363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630411111Medicaid
AL630412111Medicaid
CA100568Medicaid
AL630402111Medicaid
AL630408111Medicaid
AL630409111Medicaid
AL630405111Medicaid
AL630406111Medicaid
AL630410111Medicaid
AL630400111Medicaid
AL891017571Medicaid
AL630401111Medicaid
AL630409111Medicaid
ALP70683Medicare UPIN