Basic Information
| Provider Information | |||||||||
| NPI: | 1174758320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURRISS | ||||||||
| FirstName: | KARRIE | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNP, PMHNP- BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1195 TOWNSHIP ROAD 1193 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448059356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196065576 | ||||||||
| FaxNumber: | 4197746882 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 STERKEL BLVD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449071508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197746869 | ||||||||
| FaxNumber: | 4197746882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2009 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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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 | 163W00000X | 342727 | OH | N | Nursing Service Providers | Registered Nurse | 363LP0808X | COA.16105-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.