Provider Demographics
NPI:1760379309
Name:BURGESS, STACEY ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:BURGESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 GLENARDEN PKWY
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1711
Mailing Address - Country:US
Mailing Address - Phone:301-768-1141
Mailing Address - Fax:
Practice Address - Street 1:4302 SAINT BARNABAS RD STE G
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1842
Practice Address - Country:US
Practice Address - Phone:240-601-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR180936363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health