Provider Demographics
NPI:1760909071
Name:BURGESS, ANGELA D
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 NW 87TH TER STE 210
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-3706
Mailing Address - Country:US
Mailing Address - Phone:816-841-7779
Mailing Address - Fax:
Practice Address - Street 1:7280 NW 87TH TER STE 210
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-3706
Practice Address - Country:US
Practice Address - Phone:816-841-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO822559025Medicaid