Provider Demographics
NPI:1578714895
Name:ROGGY, JENNIFER J (ANP-BC, AOCNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:ROGGY
Suffix:
Gender:F
Credentials:ANP-BC, AOCNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC, AOCNP
Mailing Address - Street 1:11300 CORPORATE AVE
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1374
Mailing Address - Country:US
Mailing Address - Phone:913-574-2800
Mailing Address - Fax:913-574-2336
Practice Address - Street 1:2750 CLAY EDWARDS DR LOWR LEVEL010
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:913-574-1050
Practice Address - Fax:913-574-1055
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO121297163W00000X, 363LA2200X
KS45513363LA2200X
KS14-82525-042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200633470BMedicaid
MO1578714895Medicaid
MO1578714895Medicaid
KS200633470BMedicaid
MOP00975473Medicare PIN