Provider Demographics
NPI:1144789801
Name:BURRIS, LAURA LAVEE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:LAVEE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 LAKELAND DR STE 61
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4634
Mailing Address - Country:US
Mailing Address - Phone:601-982-7850
Mailing Address - Fax:
Practice Address - Street 1:970 LAKELAND DR STE 61
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4634
Practice Address - Country:US
Practice Address - Phone:601-982-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00416363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical