Healthcare Provider Details

I. General information

NPI: 1194262436
Provider Name (Legal Business Name): ANNE TUCKER RODGERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 SCHENCK ST
SHELBY NC
28150-3934
US

IV. Provider business mailing address

1809 QUEEN ST
FAYETTEVILLE NC
28303-4337
US

V. Phone/Fax

Practice location:
  • Phone: 704-480-1087
  • Fax:
Mailing address:
  • Phone: 252-673-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07010
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: