MEDICARE: MRS. AMANDA ELAINE ROGERS NP-C

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	363LF0000X	Family Nurse Practitioner	12034	TN

General Provider Information

NPI Number	:	1558319913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA ELAINE ROGERS NP-C

Provider Business Mailing Address
First Line	:	5220 PARK AVE
Second Line	:	210
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3540
Country	:	US
Telephone Number	:	901-767-6765
Fax Number	:	901-761-4312

Provider Business Practice Location Address
First Line	:	5220 PARK AVE
Second Line	:	210
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3540
Country	:	US
Telephone Number	:	901-767-6765
Fax Number	:	901-761-4312

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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