Healthcare Provider Details

I. General information

NPI: 1215186028
Provider Name (Legal Business Name): JAMES L BURRELL JR. CFNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 MCCULLOUGH BLVD
BELDEN MS
38826
US

IV. Provider business mailing address

PO BOX 353
BELDEN MS
38826-0353
US

V. Phone/Fax

Practice location:
  • Phone: 662-566-5593
  • Fax: 662-566-4419
Mailing address:
  • Phone: 662-566-5593
  • Fax: 662-566-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR866565
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: