Healthcare Provider Details

I. General information

NPI: 1407741614
Provider Name (Legal Business Name): STEPHANIE R ROGERS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 UPPER TRENT WAY
VANDALIA OH
45377-9411
US

IV. Provider business mailing address

2338 UPPER TRENT WAY
VANDALIA OH
45377-9411
US

V. Phone/Fax

Practice location:
  • Phone: 937-241-4354
  • Fax: 937-241-4354
Mailing address:
  • Phone: 937-241-4354
  • Fax: 937-241-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0039496
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.325261
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: