Provider Demographics
NPI:1255107389
Name:BURNHAM, MARY ABBYGAIL (PA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ABBYGAIL
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2850 TWIN RIVERS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4212
Mailing Address - Country:US
Mailing Address - Phone:870-246-8036
Mailing Address - Fax:870-246-7164
Practice Address - Street 1:2850 TWIN RIVERS DR STE 102
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4212
Practice Address - Country:US
Practice Address - Phone:870-246-8036
Practice Address - Fax:870-246-7164
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARPA-1224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant