Provider Demographics
NPI:1043428121
Name:ROGERS, STACI DAWN (MD)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:DAWN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACI
Other - Middle Name:DAWN
Other - Last Name:NIEMOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3800 S NATIONAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5279
Practice Address - Country:US
Practice Address - Phone:417-269-8817
Practice Address - Fax:417-269-8744
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008002542207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209118504Medicaid