Healthcare Provider Details

I. General information

NPI: 1487377131
Provider Name (Legal Business Name): BRANDY ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BRAZELTON ST UNIT 6
SAVANNAH TN
38372-3080
US

IV. Provider business mailing address

60 BRAZELTON ST UNIT 6
SAVANNAH TN
38372-3080
US

V. Phone/Fax

Practice location:
  • Phone: 731-607-2388
  • Fax:
Mailing address:
  • Phone: 731-438-3090
  • Fax: 731-256-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number168952
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32420
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number168952
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: