Provider Demographics
NPI:1649577420
Name:BURNETT, HAYLEY R (MS, ACNP-BC)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:R
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MS, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-384-4826
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD STE 10
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-384-4820
Practice Address - Fax:937-384-4826
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12195-NP363L00000X
OHAPRN.CNP.12195363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054621Medicaid
OHH046133OtherMEDICARE PTAN
OHP01597077OtherRRMEDICARE PTAN
OHCOA.12195-NPOtherLICENSE