Provider Demographics
NPI:1023061728
Name:BURGESS, NANCY C (APRN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:C
Last Name:BURGESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:WYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:702 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4207
Mailing Address - Country:US
Mailing Address - Phone:502-895-5405
Mailing Address - Fax:502-894-9544
Practice Address - Street 1:4000 KRESGE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4605
Practice Address - Country:US
Practice Address - Phone:502-897-8281
Practice Address - Fax:502-896-7266
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1106181163W00000X
KY3004584363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000537179OtherANTHEM
KY710034392Medicaid
KYP400029551Medicare PIN
KYP70978Medicare UPIN