Provider Demographics
NPI:1265496566
Name:BURGESS, KARA ALYSSA (RN, A/GNP-C)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ALYSSA
Last Name:BURGESS
Suffix:
Gender:F
Credentials:RN, A/GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:10880 BARKER CYPRESS RD
Mailing Address - Street 2:# 2203
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3050
Mailing Address - Country:US
Mailing Address - Phone:281-728-0425
Mailing Address - Fax:281-213-4524
Practice Address - Street 1:10880 BARKER CYPRESS RD
Practice Address - Street 2:# 2203
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3050
Practice Address - Country:US
Practice Address - Phone:281-728-0425
Practice Address - Fax:281-213-4524
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613799363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169631201Medicaid
TX169631201Medicaid
TX612477Medicare PIN