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General NPI Number Information
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NPI Number | 1619636222
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Entity Type | Individual
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Provider Name | MANDY MICHELLE BURTON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 147 SECTION LINE RD
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6187
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Country | US
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Telephone | 501-547-8303
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Fax |
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Provider Business Mailing Address
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Address Line | 327 KAUFMAN RD
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City | HOT SPRINGS
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State | AR
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Zip | 71913-8044
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Country | US
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Telephone | 501-650-5055
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Fax |
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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 | 218171
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License Number State | AR
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