Corlista Anne Burgess, CNM, PHMNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024170057 Issued in VA

Practice address

2604 E Pembroke Ave
Hampton, VA 23664-1248

Phone

(757) 810-2663

NPI assigned

Mar 14, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Corlista Anne Damon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12483/brand/1/csg/1/fhir/r4

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.

• Colonial OB-GYN Associates LTD

  • Obstetrics & Gynecology Physician
  • Newport News, VA
  • NPI 1801979539
  NPD (past)

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

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1982945069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 E PEMBROKE AVE",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236641248",
            "telephone_number": "757-810-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 E PEMBROKE AVE",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236641248",
            "telephone_number": "757-810-2663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "716 Denbigh Blvd Ste E2",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236084414",
            "country_code": "US",
            "telephone_number": "757-874-2790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "CORLISTA",
        "middle_name": "ANNE",
        "credential": "CNM, PHMNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-14",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "VA",
            "license": "0024170057",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024170057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORLISTA",
            "last_name": "DAMON",
            "middle_name": "ANNE",
            "credential": "CNM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nikelle Sharisse Bullock, ED. S.
• Leila Olivia Gino-Gino Bumanglag, M.D.
• Thomas Grady Bunch, LPC
• Mona G Burden-Blunt, LCSW
• Carl R Burgan, CRNA
• Mariela Iris Burgos Torres, PHARMD
• Michael Anthony Burgos, OTR/L
• Alexis Burke, OTR
• Melissa Cynthia Burke, BCBA
• Philip Burke, LPC

• All providers in Hampton, VA
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.