Healthcare Provider Details

I. General information

NPI: 1427792969
Provider Name (Legal Business Name): KAITLYN BLAND ROGERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HOSPITAL DR STE 200
BOSSIER CITY LA
71111-2169
US

IV. Provider business mailing address

2300 HOSPITAL DR STE 200
BOSSIER CITY LA
71111-2169
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7830
  • Fax: 318-212-7835
Mailing address:
  • Phone: 318-212-7830
  • Fax: 318-212-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number341091
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: