Provider Demographics
NPI:1447281621
Name:BURNETT, ZACHARY (CRNA)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:BURNETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:ZACHARY
Other - Middle Name:KIM
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8780UGOtherBCBS
TX430052681OtherRAILROAD MEDICARE
TX002603104Medicaid
TX81782HOtherBLUE CROSS BLUE SHIELD
TX002603107Medicaid
OK100785980AMedicaid
TX002603104Medicaid
TXR70094Medicare UPIN
TX340108YK6UMedicare PIN
8K8840Medicare PIN