MEDICARE: AMY BURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3010696	KY

General Provider Information

NPI Number	:	1083163737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BURSE

Provider Business Mailing Address
First Line	:	322 ATLANTIC AVE
Second Line	:
City	:	OAK GROVE
State	:	KY
Zip	:	42262-9104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 ATLANTIC AVE
Second Line	:
City	:	OAK GROVE
State	:	KY
Zip	:	42262-9104
Country	:	US
Telephone Number	:	270-348-6288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	06/09/2025

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Directions to “ AMY BURSE ” Practice Location

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