Provider Demographics
NPI:1407317837
Name:BURDEN, JERRY (PA-S)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:BURDEN
Suffix:
Gender:M
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 1:413 FOXGATE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5783
Mailing Address - Country:US
Mailing Address - Phone:757-589-1589
Mailing Address - Fax:
Practice Address - Street 1:413 FOXGATE CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5783
Practice Address - Country:US
Practice Address - Phone:757-589-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant