Jessica Lynn Burgess, APRN
Individual provider Active NPI Nurse Practitioner · Cabot, AR
NPI 1114502176 · NPPES record last updated Mar 11, 2021
Key facts
- NPI
- 1114502176
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 214955 (AR)
- Practice address
- 5830 Highway 5
Cabot, AR 72023-7328 - Phone
- (501) 941-1376
- Fax
- (501) 941-2793
- NPI assigned
- Mar 11, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210330002141 | AR | Practitioner - Nurse Practitioner | 5890102321 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tilley Family Medicine, PA | Current |
Accepting new patients |
Locations
495 Hogan Ln
Ste 1
Conway, AR 72034
Phone (501) 327-1150
Interoperability endpoints
- jessica.burgess@arcare.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 214955 | AR | Yes |
Addresses
Primary practice location
5830 Highway 5
Cabot, AR 72023-7328
Mailing address
PO Box 497
Augusta, AR 72006-0497
Phone (870) 347-2534
Other providers in Cabot, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.