Provider Demographics
NPI:1801149661
Name:BURNETTE, JACQUELINE PRICE (RN FNP-BC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:PRICE
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:RN FNP-BC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:PRICE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-8251
Mailing Address - Country:US
Mailing Address - Phone:979-968-2000
Mailing Address - Fax:979-968-2001
Practice Address - Street 1:753 E TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2353
Practice Address - Country:US
Practice Address - Phone:979-968-2000
Practice Address - Fax:979-968-2001
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily