Provider Demographics
NPI:1003076274
Name:BURNETT, AMY LAURAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LAURAN
Last Name:BURNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 ROSE ST
Mailing Address - Street 2:WING D, 4TH FLOOR
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-4000
Mailing Address - Country:US
Mailing Address - Phone:859-323-5643
Mailing Address - Fax:
Practice Address - Street 1:740 ROSE ST
Practice Address - Street 2:WING D, 4TH FLOOR
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-4000
Practice Address - Country:US
Practice Address - Phone:859-323-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5692P363L00000X
KY3005692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner