Provider Demographics
NPI:1871548586
Name:BURDEN, RUBY P (MSN, NP-C)
Entity type:Individual
Prefix:MS
First Name:RUBY
Middle Name:P
Last Name:BURDEN
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:MS
Other - First Name:RUBY
Other - Middle Name:LEE
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP-C
Mailing Address - Street 1:710 PITTMAN DR
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36089-1201
Mailing Address - Country:US
Mailing Address - Phone:334-286-4011
Mailing Address - Fax:334-286-4108
Practice Address - Street 1:1400 NARROW LN P
Practice Address - Street 2:BMA OF MONTGOMERY BAPTIST CKD SERVICES
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2654
Practice Address - Country:US
Practice Address - Phone:334-286-4011
Practice Address - Fax:334-286-4108
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-051911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-40398OtherBCBS OF ALABAMA
AL515-40398OtherBCBS OF ALABAMA