Provider Demographics
NPI:1174245575
Name:BURTON, JESSE ALLEN (CNP)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:ALLEN
Last Name:BURTON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 E PRINCESS DR APT 2013
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5811
Mailing Address - Country:US
Mailing Address - Phone:480-620-1849
Mailing Address - Fax:
Practice Address - Street 1:7900 E PRINCESS DR APT 2013
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5811
Practice Address - Country:US
Practice Address - Phone:480-620-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274336363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty