Provider Demographics
NPI:1225346380
Name:BURNETT, AUSTIN R (FNP-C)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:R
Last Name:BURNETT
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E RENFRO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3947
Mailing Address - Country:US
Mailing Address - Phone:817-295-3100
Mailing Address - Fax:817-295-3158
Practice Address - Street 1:312 E RENFRO ST
Practice Address - Street 2:STE. 101
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3947
Practice Address - Country:US
Practice Address - Phone:817-295-3100
Practice Address - Fax:817-295-3158
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX745174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218095201Medicaid
TX218095202Medicaid
TX218095203Medicaid
TXTXB114732Medicare PIN
TXTXB114728Medicare PIN
TX218095203Medicaid