Provider Demographics
NPI:1790350999
Name:ROGERS, MICHAEL RYAN (DNAP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DNAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-1634
Mailing Address - Country:US
Mailing Address - Phone:785-418-9910
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD # MS 1034
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS131423163W00000X
MO2022033814367500000X
KS557880367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse