Healthcare Provider Details

I. General information

NPI: 1669458774
Provider Name (Legal Business Name): DIANE H BURNETT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E GRAY ST STE 601
LOUISVILLE KY
40202-3902
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-3600
  • Fax: 502-588-9536
Mailing address:
  • Phone: 502-588-3600
  • Fax: 502-588-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3000686
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: