Provider Demographics
NPI:1386701621
Name:BURNETTE, KREG (MD)
Entity type:Individual
Prefix:
First Name:KREG
Middle Name:
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2386
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:
Practice Address - Street 1:1800 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2386
Practice Address - Country:US
Practice Address - Phone:702-383-1958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350851882080P0204X
NV126742080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221191OtherUNISON
OH7167702OtherAETNA
OH731269OtherBUCKEYE
PA1021120630001OtherPA MEDICAID
OH000000527951OtherANTHEM
OH2544063Medicaid
OH414954OtherWELLCARE
OHBU4210341Medicare PIN