Basic Information
| Provider Information | |||||||||
| NPI: | 1073986436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURNHAM | ||||||||
| FirstName: | SHAYLYN | ||||||||
| MiddleName: | RHAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14909 SPILLMAN RANCH LOOP | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787386551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3252263242 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2860 CREEKSIDE CIR | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417798367 | ||||||||
| FaxNumber: | 5417797471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2015 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP129491 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 202000950NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.