=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194432864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BURDS FAMILY PRACTICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2022
-----------------------------------------------------
Last Update Date | 03/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8411 PEOSTA COMMERCIAL CT
-----------------------------------------------------
City | PEOSTA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-588-6659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10768 COX SPRINGS RD
-----------------------------------------------------
City | PEOSTA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52068-9649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-451-3273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JENNIFER MARIE BURDS
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 563-451-3273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------