Provider Demographics
NPI:1902383201
Name:BURGOON, ANNIE SUSAN JOANN (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:SUSAN JOANN
Last Name:BURGOON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 KEN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2106
Mailing Address - Country:US
Mailing Address - Phone:573-424-3137
Mailing Address - Fax:
Practice Address - Street 1:204 KEN DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2106
Practice Address - Country:US
Practice Address - Phone:573-424-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX965101163W00000X
TXAP141417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse