Healthcare Provider Details

I. General information

NPI: 1891754438
Provider Name (Legal Business Name): AMY R BURRIS OGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 ASHELAND AVE
ASHEVILLE NC
28801-4013
US

IV. Provider business mailing address

143 ASHELAND AVE
ASHEVILLE NC
28801-4013
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-9191
  • Fax: 828-232-0031
Mailing address:
  • Phone: 828-258-9191
  • Fax: 828-232-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number800153
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: