Provider Demographics
NPI:1700806346
Name:BURT, MELEANA JANE (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:MELEANA
Middle Name:JANE
Last Name:BURT
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-366-6675
Mailing Address - Fax:614-366-8166
Practice Address - Street 1:2050 KENNY RD STE 1222
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221
Practice Address - Country:US
Practice Address - Phone:614-366-6675
Practice Address - Fax:614-366-8166
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.04770363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161637Medicaid
OH2161637Medicaid