Healthcare Provider Details

I. General information

NPI: 1992485536
Provider Name (Legal Business Name): AVERY HOPE ROGERS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 OLENTANGY RIVER RD STE 5320
COLUMBUS OH
43214-3937
US

IV. Provider business mailing address

6901 TRAIL PATH DR
LEWIS CENTER OH
43035-7875
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-1997
  • Fax:
Mailing address:
  • Phone: 419-577-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008317RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: