Provider Demographics
NPI:1760003495
Name:BURNETT, ANDREA G (RRT, RPSGT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:G
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RRT, RPSGT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:G
Other - Last Name:BURKLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT, RPSGT
Mailing Address - Street 1:13864 S HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-9252
Mailing Address - Country:US
Mailing Address - Phone:479-445-0604
Mailing Address - Fax:
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:479-446-0604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0914227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered