Healthcare Provider Details

I. General information

NPI: 1437749264
Provider Name (Legal Business Name): WENDY RENEE ROGERS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 6TH ST
LONGVIEW TX
75601-5567
US

IV. Provider business mailing address

6909 SUGARLAND DR
TEXARKANA AR
71854-8176
US

V. Phone/Fax

Practice location:
  • Phone: 903-297-1852
  • Fax: 903-234-1639
Mailing address:
  • Phone: 903-277-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number214651
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP1031606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: