Healthcare Provider Details

I. General information

NPI: 1487120465
Provider Name (Legal Business Name): JENNIFER BECK ROGERS APRN, A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 TRENWEST DR
WINSTON SALEM NC
27103-3208
US

IV. Provider business mailing address

3080 TRENWEST DR
WINSTON SALEM NC
27103-3208
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-0496
  • Fax: 336-768-0498
Mailing address:
  • Phone: 336-768-0496
  • Fax: 336-768-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number5011125
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5011125
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5011125
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5011125
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: