Healthcare Provider Details

I. General information

NPI: 1700175866
Provider Name (Legal Business Name): ANDREW ROSSLYN BURCHETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 RIDGEWOOD DR
PRESTONSBURG KY
41653-8832
US

IV. Provider business mailing address

900 S LIMESTONE CTW 326
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 504-940-7446
  • Fax:
Mailing address:
  • Phone: 859-323-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number46999
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: