MEDICARE: KENNETH S BURNETTE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024173331	VA
2	363LF0000X	Family Nurse Practitioner	71014917A	IN
3	363LF0000X	Family Nurse Practitioner	5017076	NC
4	363LF0000X	Family Nurse Practitioner	APRN.CNP.0035716	OH
5	163W00000X	Registered Nurse	198628	TN
6	163W00000X	Registered Nurse	41.564483	IL
7	363LF0000X	Family Nurse Practitioner	209.030704	IL
8	363LF0000X	Family Nurse Practitioner	2024004887	MO
9	363LF0000X	Family Nurse Practitioner	20898	TN

General Provider Information

NPI Number	:	1760848204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH S BURNETTE NP

Provider Business Mailing Address
First Line	:	509 MED TECH PKWY STE 100
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2579
Country	:	US
Telephone Number	:	423-952-2111
Fax Number	:	423-952-2175

Provider Business Practice Location Address
First Line	:	2320 KNOB CREEK RD STE 404
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2581
Country	:	US
Telephone Number	:	423-661-7445
Fax Number	:	423-224-3709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	02/19/2025

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