Active NPI
Maya Rae Burkett, PA
- Physician Assistant
- Greensboro, NC
National Provider Identifier
1194054841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1090147
- Practice address
- 628 Green Valley Rd
Suite 408
Greensboro, NC 27408-7730 - Phone
- (336) 315-5500
- Fax
- (336) 315-5553
- NPI assigned
- Dec 9, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1090147 | NC | Primary |
Addresses
Primary practice location
628 Green Valley Rd
Suite 408
Greensboro, NC 27408-7730
Mailing address
628 Green Valley Rd
Suite 408
Greensboro, NC 27408-7730
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1090147 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sona Medspa Physician Group, PLLC | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260316800000",
"number": "1194054841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "628 GREEN VALLEY RD",
"address_2": "SUITE 408",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274087730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "628 GREEN VALLEY RD",
"address_2": "SUITE 408",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274087730",
"telephone_number": "336-315-5500",
"fax_number": "336-315-5553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKETT",
"first_name": "MAYA",
"middle_name": "RAE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-09",
"last_updated": "2009-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "1090147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.