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:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4168
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4168
Mailing Address - Country:US
Mailing Address - Phone:208-238-1035
Mailing Address - Fax:208-239-3626
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:208-239-2110
Practice Address - Fax:208-239-2119
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID7871865363LF0000X
UT10997235-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily