MEDICARE: MRS. JESSICA LINETTE ROGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	215697	TX

General Provider Information

NPI Number	:	1154568475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LINETTE ROGERS

Provider Business Mailing Address
First Line	:	650 JOEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-798-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2085A RISHEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-3523
Country	:	US
Telephone Number	:	270-798-8400
Fax Number	:	270-798-8112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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