Healthcare Provider Details

I. General information

NPI: 1316829500
Provider Name (Legal Business Name): STACY ROGERSON CRNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ROBERTS RD STE 150
GRINDSTONE PA
15442-2104
US

IV. Provider business mailing address

111 ROBERTS RD STE 150
GRINDSTONE PA
15442-2104
US

V. Phone/Fax

Practice location:
  • Phone: 724-785-4346
  • Fax:
Mailing address:
  • Phone: 724-785-4346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033403
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: