Provider Demographics
NPI:1013965862
Name:BURON, WILLIAM MAXIME III (ANP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAXIME
Last Name:BURON
Suffix:III
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S. 4TH STREET
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT CREDENTIALING
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048
Mailing Address - Country:US
Mailing Address - Phone:913-680-6220
Mailing Address - Fax:
Practice Address - Street 1:3550 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5071
Practice Address - Country:US
Practice Address - Phone:913-680-6220
Practice Address - Fax:816-943-2767
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01527363LF0000X
MO137590363LF0000X
MO2018031144363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154714758Medicaid
AR5W708Medicare ID - Type Unspecified
AR154714758Medicaid