Provider Demographics
NPI:1487409876
Name:BURNETT, JAHLON JORDEN (RBT)
Entity type:Individual
Prefix:
First Name:JAHLON
Middle Name:JORDEN
Last Name:BURNETT
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CEYLON DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5320
Mailing Address - Country:US
Mailing Address - Phone:915-309-1875
Mailing Address - Fax:
Practice Address - Street 1:1200 GOLDEN KEY CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5820
Practice Address - Country:US
Practice Address - Phone:915-217-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBCAB942063247000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information