Healthcare Provider Details

I. General information

NPI: 1083705388
Provider Name (Legal Business Name): ERNICE LASHETTE ROGERS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 RIKE DR
PINE BLUFF AR
71603-3933
US

IV. Provider business mailing address

2306 RIKE DR
PINE BLUFF AR
71603-3933
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-2142
  • Fax:
Mailing address:
  • Phone: 870-535-2142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberA01761 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: