Provider Demographics
NPI:1265034912
Name:BURNS, CHEYANNE KAY (PMHNP)
Entity Type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:KAY
Last Name:BURNS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:CHEYANNE
Other - Middle Name:KAY
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHEYANNE BURNS
Mailing Address - Street 1:2108 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-9522
Mailing Address - Country:US
Mailing Address - Phone:951-201-7192
Mailing Address - Fax:
Practice Address - Street 1:675 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3475
Practice Address - Country:US
Practice Address - Phone:951-201-7192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015638363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health