Courtney Nichole Burrell, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME155022 Issued in FL

Practice address

109 N Doverplum Ave
Kissimmee, FL 34758-3309

Phone

(407) 943-8600

Fax

(833) 464-3641

NPI assigned

Apr 9, 2008

Last updated

Apr 13, 2023By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: courtney.burrell.1@26532.direct.athenahealth.com

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.

• Primary Care Medical Services of Poinciana Inc

  • Federally Qualified Health Center (FQHC)
  • Kissimmee, FL
  • NPI 1982002945
  NPD (past)

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1518130665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1877 FORTUNE RD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347444428",
            "telephone_number": "407-943-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N DOVERPLUM AVE",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347583309",
            "telephone_number": "407-943-8600",
            "fax_number": "833-464-3641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURRELL",
        "first_name": "COURTNEY",
        "middle_name": "NICHOLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-09",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "MD.34582",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME155022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles H Burnes IV, D.M.D.
• Melaine Alberta Rosalyn Burnett Grizzle, RN
• Jessica Lauren Burns
• Jill Marie Burnside, M.A., CCC-SLP
• Breanna Burrell
• Linda A. Burrell, MS, LMHC, NCC
• Jamie Patricia Burrows, D.O.
• Katlyn Bushey
• Katherine Elizabeth Busque, PHARMD
• Kyle Dominick Bussey

• Pediatrics Physician in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.