MEDICARE: JENNIFER DIANE BURNS

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	331686	AZ

General Provider Information

NPI Number	:	1841164266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DIANE BURNS

Provider Business Mailing Address
First Line	:	2500 CANYON RD STE A1
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8492
Country	:	US
Telephone Number	:	928-704-4499
Fax Number	:	928-704-4949

Provider Business Practice Location Address
First Line	:	2500 CANYON RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:	928-704-4499
Fax Number	:	928-704-4949

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

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	12/10/2025

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Directions to “ JENNIFER DIANE BURNS ” Practice Location

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