Healthcare Provider Details

I. General information

NPI: 1174245575
Provider Name (Legal Business Name): JESSE ALLEN BURTON CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 E BELL RD
PHOENIX AZ
85032-2138
US

IV. Provider business mailing address

3811 E BELL RD
PHOENIX AZ
85032-2138
US

V. Phone/Fax

Practice location:
  • Phone: 480-648-3030
  • Fax:
Mailing address:
  • Phone: 480-620-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number274336
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: