Provider Demographics
NPI:1861053860
Name:BURNETTE, CRISTIE ANN (NP)
Entity type:Individual
Prefix:
First Name:CRISTIE
Middle Name:ANN
Last Name:BURNETTE
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:PO BOX 1341
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-7341
Mailing Address - Country:US
Mailing Address - Phone:276-728-3332
Mailing Address - Fax:276-728-3302
Practice Address - Street 1:430 W STUART DR
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-1527
Practice Address - Country:US
Practice Address - Phone:276-728-3332
Practice Address - Fax:276-728-3302
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178626363LF0000X
NC5011911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily