Healthcare Provider Details

I. General information

NPI: 1154403160
Provider Name (Legal Business Name): JHONNY RONALD MURRUGARRA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax: 785-350-4849
Mailing address:
  • Phone: 913-682-2000
  • Fax: 785-350-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01048
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2006006977
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: