Provider Demographics
NPI:1558880799
Name:BURRESS, PAIGE DIANE (FNP-C)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:DIANE
Last Name:BURRESS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:DIANE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-3649
Mailing Address - Fax:
Practice Address - Street 1:931 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2878
Practice Address - Country:US
Practice Address - Phone:417-347-8688
Practice Address - Fax:417-347-8693
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017023499363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily