Provider Demographics
NPI:1619636222
Name:BURTON, MANDY MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:MICHELLE
Last Name:BURTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 KAUFMAN RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-8044
Mailing Address - Country:US
Mailing Address - Phone:501-650-5055
Mailing Address - Fax:
Practice Address - Street 1:147 SECTION LINE RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6187
Practice Address - Country:US
Practice Address - Phone:501-547-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR218171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily