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General NPI Number Information
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NPI Number | 1518641166
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Entity Type | Organization
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Legal Business Name | BURGESS PRIMARY FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 1211 N MAIN ST
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City | MARION
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State | SC
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Zip | 29571-2008
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Country | US
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Telephone | 843-319-6089
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1143
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City | MARION
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State | SC
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Zip | 29571-1143
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Country | US
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Telephone | 843-319-6089
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KATHY BURGESS
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Credential | NP
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Telephone | 843-319-6089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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