Provider Demographics
NPI:1215186028
Name:BURRELL, JAMES L JR (CFNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:BURRELL
Suffix:JR
Gender:M
Credentials:CFNP
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 353
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-0353
Mailing Address - Country:US
Mailing Address - Phone:662-566-5593
Mailing Address - Fax:662-566-4419
Practice Address - Street 1:2885 MCCULLOUGH BLVD
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826
Practice Address - Country:US
Practice Address - Phone:662-566-5593
Practice Address - Fax:662-566-4419
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03906898Medicaid
MS03906898Medicaid