Healthcare Provider Details

I. General information

NPI: 1588734859
Provider Name (Legal Business Name): MS. KERRY JEANNE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRY JEANNE HEIN NP

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT EXT
BERKELEY CA
94720-4303
US

IV. Provider business mailing address

279 CASTLE HILL RANCH RD
WALNUT CREEK CA
94595-2738
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2000
  • Fax:
Mailing address:
  • Phone: 925-935-9563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number262915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: