1053653220 NPI number — AMBER L. BURNS PA-C

Table of content: AMBER L. BURNS PA-C (NPI 1053653220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053653220 NPI number — AMBER L. BURNS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
AMBER
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADKINSON
Provider Other First Name:
AMBER
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053653220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73143-4670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-682-3303
Provider Business Mailing Address Fax Number:
405-384-6793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 20TH ST STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-1899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-331-1375
Provider Business Practice Location Address Fax Number:
865-331-1714
Provider Enumeration Date:
03/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  2319 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 2319 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q000328 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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