Provider Demographics
NPI:1003055575
Name:ROGERS, ANITA E (PA-C)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:E
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1757
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-1757
Mailing Address - Country:US
Mailing Address - Phone:252-598-1059
Mailing Address - Fax:252-598-0779
Practice Address - Street 1:425B S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4201
Practice Address - Country:US
Practice Address - Phone:252-598-1059
Practice Address - Fax:252-598-0779
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01703363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant