Provider Demographics
NPI:1154828051
Name:BURTON, JESSICA RENE (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENE
Last Name:BURTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:VANDERBILT
Mailing Address - State:TX
Mailing Address - Zip Code:77991-0271
Mailing Address - Country:US
Mailing Address - Phone:361-489-9903
Mailing Address - Fax:
Practice Address - Street 1:123 1ST ST
Practice Address - Street 2:
Practice Address - City:VANDERBILT
Practice Address - State:TX
Practice Address - Zip Code:77991-0271
Practice Address - Country:US
Practice Address - Phone:361-489-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206422164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse