Provider Demographics
NPI:1225562077
Name:RODGERS, RONAY (FNP)
Entity type:Individual
Prefix:MRS
First Name:RONAY
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CEDAR PLAZA PKWY
Mailing Address - Street 2:#230
Mailing Address - City:ST.LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128
Mailing Address - Country:US
Mailing Address - Phone:324-840-1003
Mailing Address - Fax:
Practice Address - Street 1:527 BENHAM ST
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1205
Practice Address - Country:US
Practice Address - Phone:573-358-9119
Practice Address - Fax:573-358-9489
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016043694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily