Provider Demographics
NPI:1508029646
Name:BURNETT, BETTY B (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:B
Last Name:BURNETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 CHURCH ST SE
Mailing Address - Street 2:PO BOX 2091
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3402
Mailing Address - Country:US
Mailing Address - Phone:256-350-1458
Mailing Address - Fax:256-350-1485
Practice Address - Street 1:1602 CHURCH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3402
Practice Address - Country:US
Practice Address - Phone:256-350-1458
Practice Address - Fax:256-350-1485
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-037625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-19871OtherBCBS
AL136527Medicaid