NPIMap

Organization Active NPI

Stan W Burleson MD PA

Doing business as Burleson Family Clinic

  • Family Medicine Physician
  • De Witt, AR
National Provider Identifier
1063104164
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
STAN W BURLESON MD PA
Doing business as
Burleson Family Clinic
Practice address
705 W 16TH St
De Witt, AR 72042-3414
Phone
(870) 946-1326
Fax
(870) 946-4577
NPI assigned
May 25, 2023
Last updated
Jun 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Stanley Wayne Burleson, MDNPI 1295839397
Title
Owner
Phone
(870) 946-1326

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

705 W 16TH St
De Witt, AR 72042-3414

Mailing address

PO Box 32
De Witt, AR 72042-0032
Phone (870) 233-2214

Other names 1

  • BURLESON FAMILY CLINIC Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D0929711Burleson Family Practice Clinic705 West 16TH, De Witt, AR 72042Provider-performed microscopyJun 22, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1063104164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32",
            "city": "DE WITT",
            "state": "AR",
            "postal_code": "720420032",
            "telephone_number": "870-233-2214",
            "fax_number": "870-946-4577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 W 16TH ST",
            "city": "DE WITT",
            "state": "AR",
            "postal_code": "720423414",
            "telephone_number": "870-946-1326",
            "fax_number": "870-946-4577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAN W BURLESON MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-25",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "BURLESON",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-946-1326",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BURLESON FAMILY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Witt, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.