MEDICARE: SAMUEL BURRESS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	207337	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	31985	TN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP70059563	WA

General Provider Information

NPI Number	:	1811620750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL BURRESS APRN

Provider Business Mailing Address
First Line	:	1415 MARRIMANS CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8576
Country	:	US
Telephone Number	:	931-629-4941
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 SEABOARD LN STE A10
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8221
Country	:	US
Telephone Number	:	931-629-4941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	10/23/2025

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