Provider Demographics
NPI:1073585279
Name:BURNS, ANGELA K (ANP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:K
Last Name:BURNS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:ANGI
Other - Middle Name:K
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:572 N SABINE PASS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-7167
Mailing Address - Country:US
Mailing Address - Phone:501-425-0205
Mailing Address - Fax:
Practice Address - Street 1:572 N SABINE PASS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-7167
Practice Address - Country:US
Practice Address - Phone:501-425-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP990280363LA2100X
ARA001323363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V341Medicare PIN