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General NPI Number Information
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NPI Number | 1194011007
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Entity Type | Individual
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Provider Name | KELLY RUSSELL BURRIS NP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 109 CARROL DR
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City | FRIES
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State | VA
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Zip | 24330-4532
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Country | US
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Telephone | 888-908-4788
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Fax | 276-398-3331
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | LAUREL FORK
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State | VA
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Zip | 24352-0009
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Country | US
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Telephone | 276-398-1200
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Fax | 336-789-0856
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5007750
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5007750
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0021469439
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024169439
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License Number State | VA
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