Provider Demographics
NPI:1871707729
Name:ROGERS, JESSICA KELLIE (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:KELLIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DO
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 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5770
Practice Address - Fax:573-331-3974
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010018426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1871707729Medicaid
A32634OtherHEALTHLINK
MOP00883009OtherRR MCR
IL1871707729Medicaid
MO699501OtherANTHEM BCBS
MO1871707729OtherTRIWEST
KY7100144870Medicaid
MO1871707729Medicaid