Provider Demographics
NPI:1013023944
Name:BURRIS, REBECCA HUSSEY (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:HUSSEY
Last Name:BURRIS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 F. E. SELLERS HIGHWAY
Mailing Address - Street 2:P O BOX 728
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654
Mailing Address - Country:US
Mailing Address - Phone:601-587-4648
Mailing Address - Fax:601-587-0613
Practice Address - Street 1:827 F. E. SELLERS HIGHWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654
Practice Address - Country:US
Practice Address - Phone:601-587-4648
Practice Address - Fax:601-587-0613
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR522481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117760Medicaid
MSS30077Medicare UPIN