Provider Demographics
NPI:1386944817
Name:BURRISS, JODIE LYNN (FNP)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:BURRISS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1314
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4404 19TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2424
Practice Address - Country:US
Practice Address - Phone:806-795-8150
Practice Address - Fax:806-791-6688
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily