Provider Demographics
NPI:1043346752
Name:BURTON, JENNY (MHPP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:MHPP
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 23047
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-0047
Mailing Address - Country:US
Mailing Address - Phone:479-452-5040
Mailing Address - Fax:
Practice Address - Street 1:1311 FORT ST.
Practice Address - Street 2:SUITE J
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923
Practice Address - Country:US
Practice Address - Phone:479-452-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator