Healthcare Provider Details

I. General information

NPI: 1982751178
Provider Name (Legal Business Name): JASON H BURK CRNA, FNP-C, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W CENTRAL AVE STE 107
EL DORADO KS
67042-2112
US

IV. Provider business mailing address

700 W CENTRAL AVE
EL DORADO KS
67042-2184
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-3300
  • Fax:
Mailing address:
  • Phone: 316-321-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77081-072
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-77081-072
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-55560-072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: