Provider Demographics
NPI:1316836752
Name:BURGESS, MADELYN GRACE (PA-S)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:GRACE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 STONE MILL WAY
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8761
Mailing Address - Country:US
Mailing Address - Phone:502-438-0361
Mailing Address - Fax:502-438-0361
Practice Address - Street 1:205 CHARLES T WETHINGTON BUILDING
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-0001
Practice Address - Country:US
Practice Address - Phone:859-257-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program