Healthcare Provider Details

I. General information

NPI: 1053120741
Provider Name (Legal Business Name): HEATHER SHAWN ROGERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13251 FALLS OF NEUSE RD STE 121
RALEIGH NC
27614-8573
US

IV. Provider business mailing address

13251 FALLS OF NEUSE RD STE 121
RALEIGH NC
27614-8573
US

V. Phone/Fax

Practice location:
  • Phone: 919-785-5055
  • Fax: 984-235-1617
Mailing address:
  • Phone: 919-785-5055
  • Fax: 984-235-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number181328
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: