Provider Demographics
NPI:1285799866
Name:BURNETT, P. SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:P.
Middle Name:SUSAN
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:501-812-7509
Mailing Address - Fax:501-812-7507
Practice Address - Street 1:3401 SPRINGHILL DR STE 155
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2934
Practice Address - Country:US
Practice Address - Phone:501-945-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5646207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105092001Medicaid
ARC67913Medicare UPIN
AR50083539Medicare PIN
AR105092001Medicaid