Healthcare Provider Details

I. General information

NPI: 1801750229
Provider Name (Legal Business Name): AMELIA BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMELIA PRICE LAT, ATC

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 US 301 N.
KENLY NC
27542
US

IV. Provider business mailing address

2430 BAY VALLEY RD
KENLY NC
27542-8257
US

V. Phone/Fax

Practice location:
  • Phone: 919-284-2031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-3865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: