Healthcare Provider Details

I. General information

NPI: 1356274716
Provider Name (Legal Business Name): JONI LEA BURGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 W 4TH ST
HOLTON KS
66436-1153
US

IV. Provider business mailing address

120 W 8TH ST
ONAGA KS
66521-9574
US

V. Phone/Fax

Practice location:
  • Phone: 785-364-3205
  • Fax:
Mailing address:
  • Phone: 785-889-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81933-122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: