Provider Demographics
NPI:1851744718
Name:ROGERS, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64856-0265
Mailing Address - Country:US
Mailing Address - Phone:417-223-4290
Mailing Address - Fax:417-223-4299
Practice Address - Street 1:5265 S BUSINESS HIGHWAY 71 STE I&J
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:MO
Practice Address - Zip Code:64856-8505
Practice Address - Country:US
Practice Address - Phone:417-223-4290
Practice Address - Fax:417-223-4299
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily