Provider Demographics
NPI:1689129470
Name:BURNETT, KARLA MICHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MICHELLE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:SMITH
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:2580 JACKSON AVE W STE 44
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5497
Mailing Address - Country:US
Mailing Address - Phone:662-234-9112
Mailing Address - Fax:
Practice Address - Street 1:2580 JACKSON AVE W STE 44
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5497
Practice Address - Country:US
Practice Address - Phone:662-234-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily