Provider Demographics
NPI:1669458774
Name:BURNETT, DIANE H (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:H
Last Name:BURNETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-3600
Mailing Address - Fax:502-588-9536
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 601
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3902
Practice Address - Country:US
Practice Address - Phone:502-588-3600
Practice Address - Fax:502-588-9536
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3000686363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200855480Medicaid
KY78003548Medicaid