Provider Demographics
NPI:1336887629
Name:BURRIS, METTA NICOLE PITTMAN (DNP, RN, AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:METTA
Middle Name:NICOLE PITTMAN
Last Name:BURRIS
Suffix:
Gender:F
Credentials:DNP, RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-4740
Mailing Address - Country:US
Mailing Address - Phone:704-699-6228
Mailing Address - Fax:
Practice Address - Street 1:101 E WT HARRIS BLVD STE 1110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3454
Practice Address - Country:US
Practice Address - Phone:704-863-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016258363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty