Basic Information
| Provider Information | |||||||||
| NPI: | 1023587714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURLESON | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1028 HIGHWAY 258 | ||||||||
| Address2: | |||||||||
| City: | BALD KNOB | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720109724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012830805 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 SHEPHERD DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721436873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012686831 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2018 | ||||||||
| LastUpdateDate: | 11/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A005945 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.