MEDICARE: JERRY BURRIS FNP

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	363LF0000X	Family Nurse Practitioner	667311	TX

General Provider Information

NPI Number	:	1336326214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY BURRIS FNP

Provider Business Mailing Address
First Line	:	PO BOX 760488
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-0488
Country	:	US
Telephone Number	:	210-523-9933
Fax Number	:	210-647-0242

Provider Business Practice Location Address
First Line	:	1911 ROGERS RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4614
Country	:	US
Telephone Number	:	210-523-9933
Fax Number	:	210-647-0242

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

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	07/21/2022

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