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 360
Mailing Address - Street 2:
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-0360
Mailing Address - Country:US
Mailing Address - Phone:620-325-2611
Mailing Address - Fax:620-325-8453
Practice Address - Street 1:1415 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-2222
Practice Address - Country:US
Practice Address - Phone:620-331-2400
Practice Address - Fax:620-331-0747
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health