Provider Demographics
NPI:1780812842
Name:BURNEY'S CLINIC INC.
Entity type:Organization
Organization Name:BURNEY'S CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:806-481-1000
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:301 3RD STREET SUITE A
Mailing Address - City:FARWELL
Mailing Address - State:TX
Mailing Address - Zip Code:79325-0683
Mailing Address - Country:US
Mailing Address - Phone:806-481-1000
Mailing Address - Fax:806-481-1005
Practice Address - Street 1:301 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:TX
Practice Address - Zip Code:79325-4669
Practice Address - Country:US
Practice Address - Phone:806-481-1000
Practice Address - Fax:806-481-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044SMOtherBLUE CROSS BLUE SHIELD
TX2075400-02OtherTEXAS HEALTH STEPS
TX2075400-01Medicaid
TXOA4856Medicare PIN