Provider Demographics
NPI:1780219907
Name:BURNS, SHIRLEY ANN (FNP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
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 1:1201 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-4509
Mailing Address - Country:US
Mailing Address - Phone:337-476-6739
Mailing Address - Fax:
Practice Address - Street 1:1201 SOUTH ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:LA
Practice Address - Zip Code:70668-4509
Practice Address - Country:US
Practice Address - Phone:337-476-6739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA212043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine