MEDICARE: MS. STACY ROGERSON CRNP, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP033403	PA

General Provider Information

NPI Number	:	1316829500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACY ROGERSON CRNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	111 ROBERTS RD STE 150
Second Line	:
City	:	GRINDSTONE
State	:	PA
Zip	:	15442-2104
Country	:	US
Telephone Number	:	724-785-4346
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 ROBERTS RD STE 150
Second Line	:
City	:	GRINDSTONE
State	:	PA
Zip	:	15442-2104
Country	:	US
Telephone Number	:	724-785-4346
Fax Number	:

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

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	06/04/2026

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