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General NPI Number Information
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NPI Number | 1801764394
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Entity Type | Organization
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Legal Business Name | STARLIGHT CLINIC PLLC
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 6701 CORPORATE DR # 4251
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City | JOHNSTON
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State | IA
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Zip | 50131-1659
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Country | US
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Telephone | 319-212-8116
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Fax |
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Provider Business Mailing Address
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Address Line | 6701 CORPORATE DR # 4251
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City | JOHNSTON
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State | IA
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Zip | 50131-1659
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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 | PSYCHIATRIST
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Name | BURGUNDY JOHNSON
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Credential | DO
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Telephone | 319-212-8116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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