Provider Demographics
NPI:1790461341
Name:BURT, AUSTIN JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:BURT
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W 14TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1215
Mailing Address - Country:US
Mailing Address - Phone:308-995-4431
Mailing Address - Fax:
Practice Address - Street 1:516 W 14TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1215
Practice Address - Country:US
Practice Address - Phone:308-995-4431
Practice Address - Fax:308-995-4098
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant