Provider Demographics
NPI:1962412635
Name:BURNS, CARLA MAE (NP)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MAE
Last Name:BURNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:MAE
Other - Last Name:QUINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1422 GALLERY PLACE DR
Mailing Address - Street 2:APT 1
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-7059
Mailing Address - Country:US
Mailing Address - Phone:254-931-1131
Mailing Address - Fax:
Practice Address - Street 1:1901 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-743-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX618503363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care