Provider Demographics
NPI:1538770409
Name:BURROUGHS, EMILY MCKINION (PMHNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MCKINION
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 HIGHWAY 6 E
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-3002
Mailing Address - Country:US
Mailing Address - Phone:662-563-8703
Mailing Address - Fax:
Practice Address - Street 1:714 3RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2312
Practice Address - Country:US
Practice Address - Phone:662-846-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904026363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health