Healthcare Provider Details

I. General information

NPI: 1396061149
Provider Name (Legal Business Name): JESSICA ELLEN BURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2010
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 DIPLOMACY DR
ANCHORAGE AK
99508-5925
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-6799
  • Fax: 907-729-8607
Mailing address:
  • Phone: 907-729-7280
  • Fax: 907-729-8607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60477323
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number186798
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: