Individual provider Active NPI

Carolee Ethel Burgess, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lancaster, CA
National Provider Identifier
1124833710
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2024068646 Issued in CA
Practice address
2010 W Avenue K # 241
Lancaster, CA 93536-5229
Phone
(818) 481-2827
NPI assigned
Feb 11, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2024068646 CA Primary

Addresses

Primary practice location

2010 W Avenue K # 241
Lancaster, CA 93536-5229

Mailing address

2010 W Avenue K # 241
Lancaster, CA 93536-5229
Phone (818) 481-2827

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251122001025 CA Practitioner - Nurse Practitioner 5294227740 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1766 E Ave
H7
Lancaster, CA 93535-6176

PO Box
Suite 451249
Los Angeles, CA 90045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2024068646CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ehab Yacoub MD Inc. CurrentSince Nov 10, 2025 Accepting new patients

Locations

500 La Terraza Blvd
Ste 150
Escondido, CA 92025
Phone (760) 232-6788

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

17075 Devonshire St
Ste 204
Northridge, CA 91325
Phone (818) 368-8929

3200 E Guasti Rd
Ste 100
Ontario, CA 91761
Phone (877) 414-7739

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1739232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1124833710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 W AVENUE K # 241",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935365229",
            "telephone_number": "818-481-2827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 W AVENUE K # 241",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935365229",
            "telephone_number": "818-481-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "CAROLEE",
        "middle_name": "ETHEL",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-11",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "2024068646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, CA

Sources for this page

Verify at the official NPI Registry.