Healthcare Provider Details

I. General information

NPI: 1013023944
Provider Name (Legal Business Name): REBECCA HUSSEY BURRIS C.F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 F. E. SELLERS HIGHWAY
MONTICELLO MS
39654
US

IV. Provider business mailing address

827 F. E. SELLERS HIGHWAY P O BOX 728
MONTICELLO MS
39654
US

V. Phone/Fax

Practice location:
  • Phone: 601-587-4648
  • Fax: 601-587-0613
Mailing address:
  • Phone: 601-587-4648
  • Fax: 601-587-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR522481
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: