Provider Demographics
NPI:1114900172
Name:ROGERS, CONSTANCE L (RN ARNP CRNA)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN ARNP CRNA
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:L
Other - Last Name:HARNISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3705 N 139TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4234
Mailing Address - Country:US
Mailing Address - Phone:913-721-3641
Mailing Address - Fax:913-721-3649
Practice Address - Street 1:904 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-2229
Practice Address - Country:US
Practice Address - Phone:816-470-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO062971163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00435049OtherRAILROAD MEDICARE
5718934OtherFIRST HEALTH
MO34698025OtherBLUE CROSS BLUE SHIELD KANSAS CITY
MO66048A008OtherTRICARE WPS
MO912676335Medicaid
MO10001784701OtherCOMMUNITY HEALTH PLAN
MO10001784701OtherCOMMUNITY HEALTH PLAN
P98780Medicare UPIN
MO66048A008OtherTRICARE WPS