Provider Demographics
NPI:1437741444
Name:BURNETT, KATIE MOORE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MOORE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LEE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:505 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-1705
Mailing Address - Country:US
Mailing Address - Phone:850-585-2276
Mailing Address - Fax:850-279-3312
Practice Address - Street 1:307 BOATNER RD STE 114
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1302
Practice Address - Country:US
Practice Address - Phone:850-883-8180
Practice Address - Fax:850-883-9702
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9462666163W00000X
FLAPRN11012193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse