Healthcare Provider Details

I. General information

NPI: 1891342531
Provider Name (Legal Business Name): KRISTEN NICOLE BURNETT M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8706 S US HIGHWAY 25
CORBIN KY
40701-4974
US

IV. Provider business mailing address

82 JOE E DELL RD
PINEVILLE KY
40977-8202
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-1166
  • Fax:
Mailing address:
  • Phone: 606-269-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number248564
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: