1932151420 NPI number — DR. JOHN A BURNETT M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932151420 NPI number — DR. JOHN A BURNETT M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BURNETT

Provider First Name:

JOHN

Provider Middle Name:

A

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1932151420

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/13/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

520 TECHWOOD DR N

Provider Second Line Business Mailing Address:

STE 100

Provider Business Mailing Address City Name:

DANVILLE

Provider Business Mailing Address State Name:

KY

Provider Business Mailing Address Postal Code:

40422-8500

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

859-936-9844

Provider Business Mailing Address Fax Number:

859-236-0320

Provider First Line Business Practice Location Address:

165 LONDON MOUNTAIN VIEW DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LONDON

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

40741-6601

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

606-862-6120

Provider Business Practice Location Address Fax Number:

606-862-6532

Provider Enumeration Date:

05/16/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0001X , with the licence number:  44181 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0001X , with the licence number: 35.053637 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0001X , with the licence number: 54956 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00120534 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 204802904 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 7100718550 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 98023 . This is a "AR BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 137052001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 3112409 . This is a "TN BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 4169616 . This is a "TN BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 3828382 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 5825694 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".