Healthcare Provider Details

I. General information

NPI: 1811469604
Provider Name (Legal Business Name): MICHAEL BURNETT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 ARNOLD DR
LITTLE ROCK AFB AR
72099-4933
US

IV. Provider business mailing address

1090 ARNOLD DR
LITTLE ROCK AFB AR
72099-4933
US

V. Phone/Fax

Practice location:
  • Phone: 501-987-2932
  • Fax:
Mailing address:
  • Phone: 501-987-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2024-0091
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11690304-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: