Healthcare Provider Details

I. General information

NPI: 1912619396
Provider Name (Legal Business Name): TAMMY ROGERS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 MOUNTAIN VIEW RD STE 115
OOLTEWAH TN
37363-6667
US

IV. Provider business mailing address

259 COVENANT DR NE
CLEVELAND TN
37323-4443
US

V. Phone/Fax

Practice location:
  • Phone: 423-541-7700
  • Fax: 423-541-7702
Mailing address:
  • Phone: 304-964-3951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP001451
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33988
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: