Provider Demographics
NPI:1689654006
Name:BURKETT, MATTHEW SHAWN (CRNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SHAWN
Last Name:BURKETT
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MCCLELLANDTOWN RD STE D
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3111
Mailing Address - Country:US
Mailing Address - Phone:724-550-4263
Mailing Address - Fax:724-550-4266
Practice Address - Street 1:280 MCCLELLANDTOWN RD STE D
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3111
Practice Address - Country:US
Practice Address - Phone:724-550-4263
Practice Address - Fax:724-550-4266
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1042418830001Medicaid