Provider Demographics
NPI:1497861645
Name:BURCHETT, BETTY ANN
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ANN
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 KINNEYS LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2805
Mailing Address - Country:US
Mailing Address - Phone:740-353-4230
Mailing Address - Fax:
Practice Address - Street 1:1042 KINNEYS LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2805
Practice Address - Country:US
Practice Address - Phone:740-353-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2192354374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH73800870Medicaid
OH2192354Medicaid