Provider Demographics
NPI:1447037965
Name:BURNETT, CLARE NELSON (FNP)
Entity type:Individual
Prefix:MRS
First Name:CLARE
Middle Name:NELSON
Last Name:BURNETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CLARE
Other - Middle Name:FRANCES
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-0676
Mailing Address - Country:US
Mailing Address - Phone:601-415-7685
Mailing Address - Fax:601-437-8499
Practice Address - Street 1:405 MARKET ST
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2024
Practice Address - Country:US
Practice Address - Phone:601-437-3113
Practice Address - Fax:601-437-3112
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily