Provider Demographics
NPI:1700329877
Name:BURCHETT, CHARLA (APRN)
Entity Type:Individual
Prefix:MISS
First Name:CHARLA
Middle Name:
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902B GRAHN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-8147
Mailing Address - Country:US
Mailing Address - Phone:606-286-0440
Mailing Address - Fax:855-825-9752
Practice Address - Street 1:6902B GRAHN RD
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-8147
Practice Address - Country:US
Practice Address - Phone:606-286-0440
Practice Address - Fax:855-825-9752
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010728363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225695851OtherTYPE 2 NPI