Basic Information
| Provider Information | |||||||||
| NPI: | 1689627796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWKIRK | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OSAWATOMIE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660641126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137553044 | ||||||||
| FaxNumber: | 9137552149 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 EAST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OSAWATOMIE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660641126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137553044 | ||||||||
| FaxNumber: | 9137552149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 09/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0421356 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100145240A | 05 | KS | MEDICAID |