Kelley Burnett, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

DO19729 Issued in OR

Practice address

700 Ramsey Ave
Grants Pass, OR 97527-5792

Phone

(541) 955-5683

Fax

(541) 955-0983

NPI assigned

Dec 5, 2005

Last updated

Aug 6, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Siskiyou Pediatric Clinic, LLP

  • Pediatrics Physician
  • Grants Pass, OR
  • NPI 1700999521
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344211200000",
    "number": "1487638235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 RAMSEY AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275792",
            "telephone_number": "541-955-5683",
            "fax_number": "541-955-0983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 RAMSEY AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275792",
            "telephone_number": "541-955-5683",
            "fax_number": "541-955-0983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "KELLEY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2012-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "DO19729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299499",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brock Anthony Bumgarner, QMHP
• Jordan Alexandria Bunting
• Chelsea C Burchette, PA-C
• Stanley A Burghardt
• George Burgi
• Alexis Burns
• Lisa Kay Burns, PHD
• Lisa Marie Burns
• Wanda Burns
• Severin Niklaus Burri

• Pediatrics Physician in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.