Provider Demographics
NPI:1356383301
Name:BURNS, LASHONDA MYCHELE (FNP)
Entity type:Individual
Prefix:
First Name:LASHONDA
Middle Name:MYCHELE
Last Name:BURNS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W INTERSTATE 20 STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5871
Mailing Address - Country:US
Mailing Address - Phone:817-468-3393
Mailing Address - Fax:817-468-8734
Practice Address - Street 1:811 W INTERSTATE 20 STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5871
Practice Address - Country:US
Practice Address - Phone:817-468-3393
Practice Address - Fax:817-468-8734
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604075363L00000X
TXAP113254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C2510Medicare ID - Type Unspecified
TXQ23897Medicare UPIN