Provider Demographics
NPI:1215183959
Name:BURNETT, KRISTY KAY (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:KAY
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MS CCC/SLP
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Mailing Address - Street 1:805 CARTER CT
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-7643
Mailing Address - Country:US
Mailing Address - Phone:479-582-2740
Mailing Address - Fax:479-582-2746
Practice Address - Street 1:46 W COLT SQUARE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2813
Practice Address - Country:US
Practice Address - Phone:479-582-2740
Practice Address - Fax:479-582-2746
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist