Healthcare Provider Details

I. General information

NPI: 1679402408
Provider Name (Legal Business Name): PAUL AARON BURGESS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SILVER MAPLE RDG APT 4
CHARLESTON WV
25306-1122
US

IV. Provider business mailing address

280 SILVER MAPLE RDG APT 4
CHARLESTON WV
25306-1122
US

V. Phone/Fax

Practice location:
  • Phone: 304-545-1798
  • Fax:
Mailing address:
  • Phone: 304-545-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number157921
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: