Provider Demographics
NPI:1649675026
Name:BURNAM, GINNY (FNP)
Entity type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:BURNAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:COPPOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3423 S SONCY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6400
Mailing Address - Country:US
Mailing Address - Phone:806-374-7341
Mailing Address - Fax:806-322-2485
Practice Address - Street 1:850 MARTIN RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-6814
Practice Address - Country:US
Practice Address - Phone:806-374-7341
Practice Address - Fax:806-374-0316
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily