MEDICARE: ASHLEY D BURGESS CNP

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	APRN.CNP.025699	OH

General Provider Information

NPI Number	:	1538703764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY D BURGESS CNP

Provider Business Mailing Address
First Line	:	211 EDGEFIELD BLVD
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-5801
Country	:	US
Telephone Number	:	740-914-4178
Fax Number	:	740-386-2640

Provider Business Practice Location Address
First Line	:	4135 TUSCARAWAS ST W
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-5463
Country	:	US
Telephone Number	:	330-546-0913
Fax Number	:	330-546-0752

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

Provider Enumeration Date	:	10/31/2019
Last Update Date	:	10/31/2019

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