Healthcare Provider Details

I. General information

NPI: 1285389049
Provider Name (Legal Business Name): JAMES BURNETT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2022
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

V. Phone/Fax

Practice location:
  • Phone: 316-249-2397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1213211
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: