Provider Demographics
NPI:1679677397
Name:BURNETTE, VERNA JEAN (PAC)
Entity Type:Individual
Prefix:MS
First Name:VERNA
Middle Name:JEAN
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:PAC
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 907
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-0907
Mailing Address - Country:US
Mailing Address - Phone:606-666-5142
Mailing Address - Fax:606-666-4172
Practice Address - Street 1:832 HWY 15 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-8601
Practice Address - Country:US
Practice Address - Phone:606-666-5142
Practice Address - Fax:606-666-4172
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183821OtherRURAL HEALTH
KY31000664OtherMEDICAID GROUP
KY6603OtherMEDICARE GROUP
KY95000923Medicaid
KYP36275Medicare UPIN