Provider Demographics
NPI:1548020886
Name:BURRIS, CARRIE GRAHAM
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:GRAHAM
Last Name:BURRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:RENAE
Other - Last Name:RIPPEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 HABITAT ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-9033
Mailing Address - Country:US
Mailing Address - Phone:986-200-3450
Mailing Address - Fax:
Practice Address - Street 1:1615 12TH AVE RD STE A
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6184
Practice Address - Country:US
Practice Address - Phone:208-467-3271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program