Provider Demographics
NPI:1053780262
Name:BURNETT, ANNE PORCHER (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:PORCHER
Last Name:BURNETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 1ST STREET
Mailing Address - Street 2:MOUNTAIN MEDICAL CLINIC
Mailing Address - City:MONTEAGLE
Mailing Address - State:TN
Mailing Address - Zip Code:37356-7401
Mailing Address - Country:US
Mailing Address - Phone:931-924-8000
Mailing Address - Fax:
Practice Address - Street 1:21 1ST STREET
Practice Address - Street 2:MOUNTAIN MEDICAL CLINIC
Practice Address - City:MONTEAGLE
Practice Address - State:TN
Practice Address - Zip Code:37356-7401
Practice Address - Country:US
Practice Address - Phone:931-924-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily