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: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N US HIGHWAY 63
LANCASTER MO
63548-1076
US

IV. Provider business mailing address

404 N US HIGHWAY 63
LANCASTER MO
63548-1076
US

V. Phone/Fax

Practice location:
  • Phone: 660-457-3655
  • Fax:
Mailing address:
  • Phone: 660-457-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06170013
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2005025560
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: