Provider Demographics
NPI:1487735650
Name:BURNS, WILLIAM DANNY (CRNA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANNY
Last Name:BURNS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-0508
Mailing Address - Country:US
Mailing Address - Phone:662-612-0013
Mailing Address - Fax:877-667-6144
Practice Address - Street 1:401 GETWELL DR
Practice Address - Street 2:PROFESSIONAL BUILDING SUITE B
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2213
Practice Address - Country:US
Practice Address - Phone:662-612-0013
Practice Address - Fax:877-667-6144
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR705993367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122658Medicaid
MS430000025Medicare ID - Type Unspecified