Provider Demographics
NPI:1073604096
Name:BURCHETT, KAREN RENE (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RENE
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WOMEN
Other - Middle Name:
Other - Last Name:FIRST, PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4328 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-5432
Mailing Address - Country:US
Mailing Address - Phone:606-327-1160
Mailing Address - Fax:606-327-1163
Practice Address - Street 1:4328 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-5432
Practice Address - Country:US
Practice Address - Phone:606-327-1160
Practice Address - Fax:606-327-1163
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008M367A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006897Medicaid
KY000000511165OtherANTHEM BCBS
KY000000583791OtherANTHEM BCBS
OH2727222Medicaid
KY78006897Medicaid
KY00399002Medicare PIN
KY00775001Medicare PIN