Healthcare Provider Details

I. General information

NPI: 1992503825
Provider Name (Legal Business Name): TAWNY CHANTEL ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

201 HUFFS RUN
GRAYSON KY
41143-7746
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-1000
  • Fax:
Mailing address:
  • Phone: 606-225-7357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4034617
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: