MEDICARE: MR. JOHNATHAN A RODRIQUEZ ARNP

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
1	363L00000X	Nurse Practitioner	53-75249-032	KS

General Provider Information

NPI Number	:	1811205214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHNATHAN A RODRIQUEZ ARNP

Provider Business Mailing Address
First Line	:	PO BOX 360
Second Line	:
City	:	NEODESHA
State	:	KS
Zip	:	66757-0360
Country	:	US
Telephone Number	:	620-325-2611
Fax Number	:	620-325-8453

Provider Business Practice Location Address
First Line	:	1415 N PENN AVE
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-2222
Country	:	US
Telephone Number	:	620-331-2400
Fax Number	:	620-331-0747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	05/22/2026

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