Healthcare Provider Details

I. General information

NPI: 1225977960
Provider Name (Legal Business Name): DUSTIN COLLINS BURCHETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 E NEW CIRCLE RD STE 190
LEXINGTON KY
40509-1044
US

IV. Provider business mailing address

113 STRODE STATION CIR
WINCHESTER KY
40391-1031
US

V. Phone/Fax

Practice location:
  • Phone: 859-329-1181
  • Fax:
Mailing address:
  • Phone: 859-329-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1215060
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: