Individual
JACQUELYN BURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24530 FALCON PLACE BLVD, SUITE 100, ABINGDON, VA 24211-7665
(276) 619-0075
(276) 619-0077
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 400-8722
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101257167
VA
207Q00000X
Family Medicine Physician
Primary
27664
TN
Other
Enumeration date
01/13/2014
Last updated
01/26/2015
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