Active NPI
Jacquelyn Burt
- Family Medicine Physician
- Abingdon, VA
National Provider Identifier
1003238940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 27664
- Practice address
- 24530 Falcon Place Blvd
Suite 100
Abingdon, VA 24211-7665 - Phone
- (276) 619-0075
- Fax
- (276) 619-0077
- NPI assigned
- Jan 13, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 27664 | TN | Primary |
| Family Medicine Physician | 207Q00000X | 0101257167 | VA |
Addresses
Primary practice location
24530 Falcon Place Blvd
Suite 100
Abingdon, VA 24211-7665
Mailing address
105 W Stone Dr
Suite 6a
Kingsport, TN 37660-3365
Phone (423) 400-8722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27664 | TN | MD | Family Medicine Physician |
| 0101257167 | VA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422230400000",
"number": "1003238940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 W STONE DR",
"address_2": "SUITE 6A",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376603365",
"telephone_number": "423-400-8722",
"fax_number": "423-408-7405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24530 FALCON PLACE BLVD",
"address_2": "SUITE 100",
"city": "ABINGDON",
"state": "VA",
"postal_code": "242117665",
"telephone_number": "276-619-0075",
"fax_number": "276-619-0077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURT",
"first_name": "JACQUELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-13",
"last_updated": "2015-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TN",
"license": "27664",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101257167",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Abingdon, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.