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NPI Code Detail

MEDICARE: JONATHAN BURKETT

MEDICARE:   JONATHAN  BURKETT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantPA.0006518CO

General Provider Information

NPI Number : 1376171967
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BURKETT
Provider Business Mailing Address
First Line : 8075 GARRISON CT APT A
Second Line :
City : ARVADA
State : CO
Zip : 80005-2296
Country : US
Telephone Number : 970-691-0064
Fax Number :
Provider Business Practice Location Address
First Line : 1715 N WEBER ST STE 90
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7524
Country : US
Telephone Number : 970-691-0064
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2020
Last Update Date : 01/26/2022

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Directions to “ JONATHAN BURKETT ” Practice Location

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