Provider Demographics
NPI:1255669784
Name:BURNETTE, JILLIAN PATRICE
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:PATRICE
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 NICHOLASVILLE RD
Mailing Address - Street 2:# 11410
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-6346
Mailing Address - Country:US
Mailing Address - Phone:859-539-3930
Mailing Address - Fax:
Practice Address - Street 1:3800 NICHOLASVILLE RD
Practice Address - Street 2:# 11410
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-6346
Practice Address - Country:US
Practice Address - Phone:859-539-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst