NICHOLAS TATE BURRIS
NPI 1417651969
Student in an Organized Health Care Education/Training Program in Madisonville, KY

Q: What is Nicholas Burris's NPI number?

The NPI number for Nicholas Burris is 1417651969. It was assigned to this individual provider in the NPPES registry on March 29, 2023.

Q: What is Nicholas Burris's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Nicholas Burris was last updated on March 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 29, 2023PECOS Enrolled

900 HOSPITAL DR, MADISONVILLE, KY 42431(270) 825-5100 Get Directions Write a Review

NPPES record last updated: March 29, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Nicholas Tate Burris NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLAS TATE BURRIS (NPI 1417651969) is an individual student in an organized health care education/training program in Madisonville, Kentucky and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS and is a graduate of University Of Louisville School Of Medicine (2025).

NPPES Registry Identity

NPI1417651969

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameNICHOLAS TATE BURRIS

Location Address900 HOSPITAL DRMadisonville, KY 42431-1644

Mailing Address380 Country Club Ln Apt FMadisonville, KY 42431-3836 · (270) 619-1609

Phone(270) 825-5100

Sole ProprietorNo

Medical School CMSUniversity Of Louisville School Of MedicineGraduated 2025

Enumeration DateMarch 29, 2023

NPPES CertifiedMarch 29, 2023

✔ NPI 1417651969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

900 HOSPITAL DR, Madisonville, KY 42431

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicholas Tate Burris is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8022572163

PECOS Enrollment IDI20260709004288

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CADE CUNNINGHAM

Pharmacist