Provider Demographics
NPI:1700193174
Name:BURNETTE, ERIN RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:RENEE
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOSPITAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-9227
Mailing Address - Country:US
Mailing Address - Phone:417-533-6751
Mailing Address - Fax:
Practice Address - Street 1:120 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9227
Practice Address - Country:US
Practice Address - Phone:417-533-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1202X
MO2021023839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician