Mary Powell Burgess
Individual provider Active NPI Registered Nurse · Jefferson, NC
NPI 1417320409 · NPPES record last updated Nov 12, 2015
Key facts
- NPI
- 1417320409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 643722 (NC)
- Practice address
- 418 E Main St
Jefferson, NC 28640-8984 - Phone
- (336) 246-9492
- NPI assigned
- Nov 12, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 643722 | NC | MD | Registered Nurse |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 643722 | NC | Yes |
Addresses
Primary practice location
418 E Main St
Jefferson, NC 28640-8984
Mailing address
PO Box 5
West Jefferson, NC 28694-0005
Phone (336) 246-9492
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7700417 | Medicaid | NC |
Other providers in Jefferson, NC
- Elizabeth Leigh Bradley
- Barbara Ann Brown
- Meagan Hammond Brown
- Amanda Dancy Bundy
- Leon Carlton Burgess Jr.
- Mari Lynne Butler
- Christopher Michael Byrd
- Ethelin Camille Cammock
- Christopher Darrell Campbell
- Daniel Caputo
All providers in Jefferson, NC · Registered Nurse in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.