Provider Demographics
NPI:1871397562
Name:BURNETT, AVERY MARIE (NP)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:MARIE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-9417
Mailing Address - Country:US
Mailing Address - Phone:919-610-4357
Mailing Address - Fax:
Practice Address - Street 1:2480 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-9417
Practice Address - Country:US
Practice Address - Phone:919-610-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10997235-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily