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NPI Code Detail

MEDICARE: LATASHA REGENIA ROGERS NP

MEDICARE: LATASHA REGENIA ROGERS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner5003950NC
2363LP0808XPsychiatric/Mental Health Nurse Practitioner5003950NC

General Provider Information

NPI Number : 1588834030
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATASHA REGENIA ROGERS NP
Provider Business Mailing Address
First Line : 19701 BETHEL CHURCH RD # 103-233
Second Line :
City : CORNELIUS
State : NC
Zip : 28031-4072
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10150 MALLARD CREEK RD STE 104
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-4567
Country : US
Telephone Number : 980-242-7090
Fax Number : 980-556-7219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2008
Last Update Date : 06/03/2026

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