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NPI Code Detail

MEDICARE: DIANA LYNN BURCHETT PAT

MEDICARE: DIANA LYNN BURCHETT PAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZA2600XMedical Art Specialist/Technologist0147KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1184607OTHERKYMEDICARE GROUP NUMBER

General Provider Information

NPI Number : 1508804865
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA LYNN BURCHETT PAT
Provider Business Mailing Address
First Line : 502 FARRELL DR
Second Line :
City : COVINGTON
State : KY
Zip : 41011-3717
Country : US
Telephone Number : 859-331-3292
Fax Number : 859-578-2864
Provider Business Practice Location Address
First Line : 502 FARRELL DR
Second Line :
City : COVINGTON
State : KY
Zip : 41011-3717
Country : US
Telephone Number : 859-331-3292
Fax Number : 859-578-2864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 07/08/2007

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Directions to “ DIANA LYNN BURCHETT PAT” Practice Location

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