Provider Demographics
NPI:1912943408
Name:BURGOYNE, JENNIFER K (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:BURGOYNE
Suffix:
Gender:F
Credentials:MD
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 743
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0743
Mailing Address - Country:US
Mailing Address - Phone:316-425-0445
Mailing Address - Fax:316-425-0460
Practice Address - Street 1:9300 E 29TH ST N STE 315
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2184
Practice Address - Country:US
Practice Address - Phone:316-425-0445
Practice Address - Fax:316-425-0460
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS29078207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12149479OtherMULTIPLAN
KS100392290AMedicaid
KS206313OtherHPK
KS9468OtherPHS
KS100898OtherBCBS
KS82259OtherCOVENTRY
KS82259OtherCOVENTRY
KS100898Medicare ID - Type Unspecified