Healthcare Provider Details

I. General information

NPI: 1174758320
Provider Name (Legal Business Name): KARRIE KAY BURRISS CNP, PMHNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 STERKEL BLVD
MANSFIELD OH
44907-1508
US

IV. Provider business mailing address

1195 TOWNSHIP ROAD 1193
ASHLAND OH
44805-9356
US

V. Phone/Fax

Practice location:
  • Phone: 419-774-6869
  • Fax: 419-774-6882
Mailing address:
  • Phone: 419-606-5576
  • Fax: 419-774-6882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number342727
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.16105-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: