Healthcare Provider Details

I. General information

NPI: 1053188813
Provider Name (Legal Business Name): RYAN CODY BURNS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N LEE TREVINO DR STE B
EL PASO TX
79936-2116
US

IV. Provider business mailing address

11331 JAMES WATT DR BLDG 100
EL PASO TX
79936-6401
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-7465
  • Fax:
Mailing address:
  • Phone: 915-206-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1131784
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: