Provider Demographics
NPI:1881580082
Name:BURSE, COEWONDA LEQESHA (FNP)
Entity type:Individual
Prefix:
First Name:COEWONDA
Middle Name:LEQESHA
Last Name:BURSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:COEWONDA
Other - Middle Name:LEQESHA
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 BROOKLYNN ST
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-4517
Mailing Address - Country:US
Mailing Address - Phone:662-571-6646
Mailing Address - Fax:
Practice Address - Street 1:129 BROOKLYNN ST
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-4517
Practice Address - Country:US
Practice Address - Phone:662-571-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907444363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner