Individual
JILL BURBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
802 W BROADWAY, STAFFORD, KS 67578
(620) 234-6826
(620) 234-5014
Mailing address
802 W BROADWAY, PO BOX 309, STAFFORD, KS 67578
(620) 234-6826
(620) 234-5014
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1501002
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200306410A
—
KS
01
—
426817
BLUE CROSS BLUE SHIELD
KS
Enumeration date
10/11/2006
Last updated
01/07/2008
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