Basic Information
| Provider Information | |||||||||
| NPI: | 1629459367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W WORLEY ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652032037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738866741 | ||||||||
| FaxNumber: | 5736072885 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652811037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6603886446 | ||||||||
| FaxNumber: | 6603886870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2015 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2004018896 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.