Provider Demographics
NPI:1891754438
Name:BURRIS, AMY R (OGNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:BURRIS
Suffix:
Gender:F
Credentials:OGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 ASHELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4013
Mailing Address - Country:US
Mailing Address - Phone:828-258-9191
Mailing Address - Fax:828-232-0031
Practice Address - Street 1:143 ASHELAND AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4013
Practice Address - Country:US
Practice Address - Phone:828-258-9191
Practice Address - Fax:828-232-0031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800153363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S96236Medicare UPIN
2599115Medicare ID - Type Unspecified