Healthcare Provider Details

I. General information

NPI: 1003076274
Provider Name (Legal Business Name): AMY LAURAN BURNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 ROSE ST WING D, 4TH FLOOR
LEXINGTON KY
40536-4000
US

IV. Provider business mailing address

740 ROSE ST WING D, 4TH FLOOR
LEXINGTON KY
40536-4000
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5643
  • Fax:
Mailing address:
  • Phone: 859-323-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5692P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3005692
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: