Provider Demographics
NPI:1811205214
Name:RODRIQUEZ, JOHNATHAN A (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:A
Last Name:RODRIQUEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301
Mailing Address - Country:US
Mailing Address - Phone:620-331-2400
Mailing Address - Fax:620-331-2405
Practice Address - Street 1:1415 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301
Practice Address - Country:US
Practice Address - Phone:620-331-2400
Practice Address - Fax:620-331-2405
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health