Healthcare Provider Details

I. General information

NPI: 1447790423
Provider Name (Legal Business Name): TABITHA SARAH ROHR NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55682 STATE HIGHWAY 6 STE A
EDINA MO
63537-4268
US

IV. Provider business mailing address

55682 STATE HIGHWAY 6 STE A
EDINA MO
63537-4268
US

V. Phone/Fax

Practice location:
  • Phone: 660-460-8140
  • Fax: 660-460-8143
Mailing address:
  • Phone: 660-460-8140
  • Fax: 660-460-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2005025560
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017018176
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: