Provider Demographics
NPI:1629459367
Name:ROGERS, AMANDA JO (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W WORLEY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2037
Mailing Address - Country:US
Mailing Address - Phone:573-886-6741
Mailing Address - Fax:573-607-2885
Practice Address - Street 1:307 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MO
Practice Address - Zip Code:65281-1037
Practice Address - Country:US
Practice Address - Phone:660-388-6446
Practice Address - Fax:660-388-6870
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily