Provider Demographics
NPI:1194987438
Name:BURKETT, DENISE ANN (ARNP WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ANN
Last Name:BURKETT
Suffix:
Gender:F
Credentials:ARNP WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 WESTWOOD FARMS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5023
Mailing Address - Country:US
Mailing Address - Phone:502-493-1082
Mailing Address - Fax:
Practice Address - Street 1:3000 ASH AVE
Practice Address - Street 2:
Practice Address - City:PEWEE VALLEY
Practice Address - State:KY
Practice Address - Zip Code:40056
Practice Address - Country:US
Practice Address - Phone:502-241-8454
Practice Address - Fax:502-241-3067
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3362P363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP30579Medicare UPIN
KY0705403Medicare PIN