MEDICARE: MS. JESSICA ROGERS CPNP-AC, 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	163W00000X	Registered Nurse	RN.402716	OH
2	363LP0200X	Pediatric Nurse Practitioner	APRN.CNP.021514	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.021514	OH
4	363L00000X	Nurse Practitioner	APRN.CNP.021514	OH

General Provider Information

NPI Number	:	1477063758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA ROGERS CPNP-AC, PMHNP-BC

Provider Business Mailing Address
First Line	:	4270 CLIFFORD RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-3111
Country	:	US
Telephone Number	:	513-477-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 BURNET AVE # 2010
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3026
Country	:	US
Telephone Number	:	513-636-4415
Fax Number	:	513-636-7805

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	05/11/2023

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