1114900172 NPI number — MS. CONSTANCE L ROGERS RN ARNP CRNA

Table of content: MS. CONSTANCE L ROGERS RN ARNP CRNA (NPI 1114900172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114900172 NPI number — MS. CONSTANCE L ROGERS RN ARNP CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
CONSTANCE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN ARNP CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARNISH
Provider Other First Name:
CONSTANCE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114900172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3705 N 139TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66109-4234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-721-3641
Provider Business Mailing Address Fax Number:
913-721-3649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
904 WOLLARD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64085-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-470-5432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  062971 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 062971 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00435049 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5718934 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34698025 . This is a "BLUE CROSS BLUE SHIELD KANSAS CITY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 66048A008 . This is a "TRICARE WPS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 912676335 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10001784701 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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