Provider Demographics
NPI:1184272767
Name:RODGERS, JAYWANNA (OWNER)
Entity type:Individual
Prefix:
First Name:JAYWANNA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CTY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 E ASHLEY ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CTY
Practice Address - State:MO
Practice Address - Zip Code:65101-3411
Practice Address - Country:US
Practice Address - Phone:816-457-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty