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General NPI Number Information
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NPI Number | 1821689720
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Entity Type | Individual
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Provider Name | DANEISHA LATRELL ROGERS DNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 283 MARTIN LUTHER KING JR BLVD
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City | BLAKELY
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State | GA
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Zip | 39823-3455
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Country | US
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Telephone | 292-261-9884
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Fax | 229-261-9895
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Provider Business Mailing Address
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Address Line | PO BOX 4715
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City | DONALSONVILLE
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State | GA
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Zip | 39845-4715
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Country | US
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Telephone | 229-309-9079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN243862
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License Number State | GA
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