Provider Demographics
NPI:1144388695
Name:CAUTHORNE-BURNETTE, TAMERA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:
Last Name:CAUTHORNE-BURNETTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8935 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6323
Mailing Address - Country:US
Mailing Address - Phone:804-767-8300
Mailing Address - Fax:804-754-0158
Practice Address - Street 1:12268 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:VA
Practice Address - Zip Code:23146-1627
Practice Address - Country:US
Practice Address - Phone:804-749-4006
Practice Address - Fax:804-749-4006
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017000831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010043077Medicaid
VA010043077Medicaid
VAP26991Medicare UPIN