Provider Demographics
NPI:1336296599
Name:BURTON, WENDY E (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:BURTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:E
Other - Last Name:BISSET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:937 MADISON 3636
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:AR
Mailing Address - Zip Code:72742-8003
Mailing Address - Country:US
Mailing Address - Phone:816-401-2560
Mailing Address - Fax:
Practice Address - Street 1:1741 US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3096
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:203-590-8644
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36771207Q00000X
MO2008030938207Q00000X
IL336-073301207Q00000X
KS04-32811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS553A00001Medicare PIN