Individual
SARA BURWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
764 LAKELAND DR, JACKSON, MS 39216-4651
(601) 984-5160
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5160
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R878011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04930854
—
MS
Enumeration date
10/28/2013
Last updated
09/08/2017
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