# BURGESS PRIMARY FAMILY PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518641166
- **Authorized official:** MRS. KATHY BURGESS NP (OWNER)
- **Authorized official phone:** (843) 319-6089

## Contact information

- **Practice address:** 1211 N MAIN ST, MARION, SC 29571-2008
- **Practice address phone:** (843) 319-6089
- **Mailing address:** PO BOX 1143, MARION, SC 29571-1143
- **Mailing address phone:** (843) 319-6089

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LC1500X | Community Health Nurse Practitioner | — | NULL | — |
| 363LC1500X | Community Health Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | NULL | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |
| 363LX0106X | Occupational Health Nurse Practitioner | — | NULL | — |
| 363LX0106X | Occupational Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/14/2023
- **Last updated:** 01/03/2024