Healthcare Provider Details

I. General information

NPI: 1740468495
Provider Name (Legal Business Name): BRIDGETT ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ALDERSGATE RD SUITE 200
LITTLE ROCK AR
72205-6614
US

IV. Provider business mailing address

2200 DENVER DR
JONESBORO AR
72401-4606
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-0720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2749-B
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: