Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2014019431 | MO |
Y | 2084N0402X | Child Neurologist | TP248 | KY |
NPI | 1114332236 |
---|---|
Provider Name | Amanda Brian Rogers |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Louisville, KY 40202-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2014 |
Last Update Date | 27/10/2020 |