Healthcare Provider Details

I. General information

NPI: 1265057632
Provider Name (Legal Business Name): JUSTIN BURNS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 8TH AVE STE 300
FORT WORTH TX
76104-4131
US

IV. Provider business mailing address

891 EUREKA ST
WEATHERFORD TX
76086-5807
US

V. Phone/Fax

Practice location:
  • Phone: 817-912-9270
  • Fax:
Mailing address:
  • Phone: 817-599-1200
  • Fax: 817-341-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: