MEDICARE: MS. TRACY CLEMENT ROGERS MS RD LDN

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	133V00000X	Registered Dietitian	L002454	NC

General Provider Information

NPI Number	:	1710082573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY CLEMENT ROGERS MS RD LDN

Provider Business Mailing Address
First Line	:	209 N 35TH ST
Second Line	:	SUITE B3
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3183
Country	:	US
Telephone Number	:	252-241-0369
Fax Number	:	888-813-7814

Provider Business Practice Location Address
First Line	:	209 N 35TH ST
Second Line	:	SUITE B3
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3183
Country	:	US
Telephone Number	:	252-241-0369
Fax Number	:	888-813-7814

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	01/14/2010

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