Healthcare Provider Details

I. General information

NPI: 1164334074
Provider Name (Legal Business Name): PASSIAN BURTON AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 TOURNAMENT WAY
MONTGOMERY AL
36116-6038
US

IV. Provider business mailing address

7055 TOURNAMENT WAY
MONTGOMERY AL
36116-6038
US

V. Phone/Fax

Practice location:
  • Phone: 334-306-2058
  • Fax:
Mailing address:
  • Phone: 334-306-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-134573
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: