Healthcare Provider Details

I. General information

NPI: 1598684896
Provider Name (Legal Business Name): BIANCA BURNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12173 MAIN ST STE B
MASON TN
38049-7067
US

IV. Provider business mailing address

6000 POPLAR AVE
MEMPHIS TN
38119-3981
US

V. Phone/Fax

Practice location:
  • Phone: 901-403-8432
  • Fax:
Mailing address:
  • Phone: 901-606-4634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number41971
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: