Provider Demographics
NPI:1174758320
Name:BURRISS, KARRIE KAY (CNP, PMHNP- BC)
Entity type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:KAY
Last Name:BURRISS
Suffix:
Gender:F
Credentials:CNP, PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 TOWNSHIP ROAD 1193
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-9356
Mailing Address - Country:US
Mailing Address - Phone:419-606-5576
Mailing Address - Fax:419-774-6882
Practice Address - Street 1:270 STERKEL BLVD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1508
Practice Address - Country:US
Practice Address - Phone:419-774-6869
Practice Address - Fax:419-774-6882
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH342727163W00000X
OHCOA.16105-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse