Amanda Lori Burgess

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

280404 Issued in AZ

Practice address

1422 E Lark St
Gilbert, AZ 85297-4577

Phone

(480) 603-7380

NPI assigned

Mar 1, 2022

Last updated

Sep 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Renew Wellness, LLC

  dba ReNew Wellness

  • Multi-Specialty Clinic/Center
  • Gilbert, AZ
  • NPI 1104476993
  Medicare reassignment NPD

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1508512302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1422 E LARK ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852974577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1422 E LARK ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852974577",
            "telephone_number": "480-603-7380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "AMANDA",
        "middle_name": "LORI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "RN144952",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "280404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clinton Ray Bunker, PT,DPT
• Thomas Buonopane, RBT
• Nicole Burbank
• Jasmine Burch, BCBA, LBA
• Julie Rae Burdick
• Suzanne Maria Burgess, OT
• Lisa Nicole Burgin, FNP-C
• Cassandra Grace Burk
• Debra Burklund, MA, LPC, LISAC
• Jennifer Mae Burkmier, RN

• Psychiatric/Mental Health Nurse Practitioner in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.