Healthcare Provider Details

I. General information

NPI: 1851171789
Provider Name (Legal Business Name): TEQUILA MARIE ROGERS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 PYRAMID WAY STE B
SPARKS NV
89431-5053
US

IV. Provider business mailing address

438 PYRAMID WAY STE B
SPARKS NV
89431-5053
US

V. Phone/Fax

Practice location:
  • Phone: 304-573-1992
  • Fax: 775-547-2050
Mailing address:
  • Phone: 775-241-8153
  • Fax: 775-800-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number830041
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: