Provider Demographics
NPI:1760920458
Name:ROE, SONYA K (FNP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:K
Last Name:ROE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2405
Mailing Address - Country:US
Mailing Address - Phone:816-233-8536
Mailing Address - Fax:816-233-5296
Practice Address - Street 1:904 S 10TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-2405
Practice Address - Country:US
Practice Address - Phone:816-233-8536
Practice Address - Fax:816-233-5296
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily