Provider Demographics
NPI:1669410510
Name:BURNETTE, DAVID (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:5 E ALVON ROAD SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:2860 3RD AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1454
Practice Address - Country:US
Practice Address - Phone:304-525-3711
Practice Address - Fax:304-525-2748
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001719576OtherBLUE CROSS BLUE SHIELD
WVP00949891OtherRR MEDICARE
KY7100170150Medicaid
WV3001162OtherWORKERS COMPENSATION
WVP64901Medicare UPIN
WVP00372232Medicare PIN
WVBUPA19342Medicare PIN
WV0102AMedicare PIN