Provider Demographics
NPI:1164555298
Name:BURNS, ELAINE K (DPH)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:K
Last Name:BURNS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 SKIPPING STONE DR
Mailing Address - Street 2:
Mailing Address - City:APISON
Mailing Address - State:TN
Mailing Address - Zip Code:37302-7543
Mailing Address - Country:US
Mailing Address - Phone:423-236-4660
Mailing Address - Fax:
Practice Address - Street 1:2962 SKIPPING STONE DR
Practice Address - Street 2:
Practice Address - City:APISON
Practice Address - State:TN
Practice Address - Zip Code:37302-7543
Practice Address - Country:US
Practice Address - Phone:423-236-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024728183500000X
TN33415183500000X
GARPH025181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist