Doctor Name: | CANDICE BRIANNE BURNSIDE |
NPI Number: | 1013320373 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | A004095 |
Business Practice Address: | 225 E Jackson Ave Jonesboro, AR - 724013119 |
Business Phone Number: | 8702071630 |
Business Fax Number: | |
Mailing Address: | 225 E Jackson Ave, JONESBORO |
State: | AR |
Postal Code: | 724013119 |
Phone Number: | 8702071630 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2014 |
NPI Last Update Date: | 05/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A004095 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |