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General NPI Number Information
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NPI Number | 1134038516
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Entity Type | Individual
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Provider Name | JONATHAN WIEMKEN ATC/L
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Gender | Male
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 2425 VENTURE PARK DR
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City | LAWRENCE
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State | KS
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Zip | 66046-5513
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Country | US
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Telephone | 260-846-1068
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 STATE AVE APT 1-610
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City | KANSAS CITY
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State | KS
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Zip | 66112-3016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | 24-01748
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License Number State | KS
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