Provider Demographics
NPI:1538860846
Name:ROGERS, TAMARA TAMEKA (MSN, BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:TAMEKA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ELMGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2010
Mailing Address - Country:US
Mailing Address - Phone:314-778-0045
Mailing Address - Fax:
Practice Address - Street 1:6231 SANDYCREEK CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-4942
Practice Address - Country:US
Practice Address - Phone:314-699-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201304519163WH0500X, 163WW0000X, 163WA2000X, 163W00000X, 163WC0400X, 163WD1100X, 163WH0200X
MO2013045199163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WH0200XNursing Service ProvidersRegistered NurseHome Health