Provider Demographics
NPI:1124562350
Name:BURRESS, NAMINYA (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:NAMINYA
Middle Name:
Last Name:BURRESS
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N HIGHWAY 67 STE D1
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6069
Mailing Address - Country:US
Mailing Address - Phone:972-291-7181
Mailing Address - Fax:
Practice Address - Street 1:420 N HIGHWAY 67 STE D1
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6069
Practice Address - Country:US
Practice Address - Phone:972-291-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant