Healthcare Provider Details

I. General information

NPI: 1164836177
Provider Name (Legal Business Name): STEPHANIE AMBER BURGESS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 W TIPTON ST SUITE D
SEYMOUR IN
47274-2793
US

IV. Provider business mailing address

1171 W TIPTON ST SUITE D
SEYMOUR IN
47274-2793
US

V. Phone/Fax

Practice location:
  • Phone: 812-524-8780
  • Fax:
Mailing address:
  • Phone: 812-524-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28191679A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: