Provider Demographics
NPI:1477281475
Name:BURNETT, KELLY (LM CPM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 FARM ROAD 71 W
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-0416
Mailing Address - Country:US
Mailing Address - Phone:423-385-0713
Mailing Address - Fax:
Practice Address - Street 1:2071 FARM ROAD 71 W
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-0416
Practice Address - Country:US
Practice Address - Phone:423-385-0713
Practice Address - Fax:469-886-1901
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife