Healthcare Provider Details

I. General information

NPI: 1558270645
Provider Name (Legal Business Name): KOREY MICHAEL BURROW BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5985 HIGHWAY 106
ELLINGTON MO
63638-9136
US

IV. Provider business mailing address

5985 HIGHWAY 106
ELLINGTON MO
63638-9136
US

V. Phone/Fax

Practice location:
  • Phone: 573-202-8771
  • Fax:
Mailing address:
  • Phone: 573-202-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2021019503
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: