Basic Information
| Provider Information | |||||||||
| NPI: | 1609362961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | MADELINE | ||||||||
| MiddleName: | WILSON | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 286 ZANDALE DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025586669 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251362199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044425151 | ||||||||
| FaxNumber: | 3044427494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2018 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 106709 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0200X | 3012466 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.