Individual provider Active NPI

Brittany Lasha Burris, APRN

  • Family Nurse Practitioner
  • Conway, AR
National Provider Identifier
1790286904
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A005495 Issued in AR
Practice address
2200 Ada Ave Ste 201
Conway, AR 72034-4984
Phone
(501) 852-1360
Fax
(501) 552-5316
NPI assigned
Feb 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A005495 AR Primary

Addresses

Primary practice location

2200 Ada Ave Ste 201
Conway, AR 72034-4984

Mailing address

2200 Ada Ave Ste 201
Conway, AR 72034-4984
Phone (501) 852-1360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20180507001092 AR Practitioner - Nurse Practitioner 7911261565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conway Regional Medical Center IncGroup PAC ID 3173428414, 129 clinicians

Practice addresses (Care Compare)

2200 Ada Ave
Suite 201
Conway, AR 72034-4984
Phone (501) 852-1360

Hospital & facility affiliations

  • Conway Regional Medical Center, Inc Hospital, Conway, AR, CCN 040029

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Regional Medical Center, Inc. Current Accepting new patients
Conway Regional Medical Center Inc CurrentSince Feb 1, 2023 Accepting new patients
Conway Regional Medical Center, Inc CurrentSince Feb 1, 2023 Accepting new patients
St Marys Physician Services, LLC Past Accepting new patients
Conway Regional Medical Center Inc Past Accepting new patients

Locations

2200 Ada Ave
Ste 201
Conway, AR 72034
Phone (501) 852-1360

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1790286904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 ADA AVE STE 201",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344984",
            "telephone_number": "501-852-1360",
            "fax_number": "501-552-5316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 ADA AVE STE 201",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344984",
            "telephone_number": "501-852-1360",
            "fax_number": "501-552-5316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURRIS",
        "first_name": "BRITTANY",
        "middle_name": "LASHA",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-22",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A005495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.