Provider Demographics
NPI:1609362961
Name:BURNS, MADELINE WILSON (APRN)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:WILSON
Last Name:BURNS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 ZANDALE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2660
Mailing Address - Country:US
Mailing Address - Phone:502-558-6669
Mailing Address - Fax:
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2199
Practice Address - Country:US
Practice Address - Phone:304-442-5151
Practice Address - Fax:304-442-7494
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV106709363L00000X
KY3012466363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics