Provider Demographics
NPI:1033340690
Name:ROGERS, JAMES JASON (NP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JASON
Last Name:ROGERS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 COUNTY ROAD 6
Mailing Address - Street 2:
Mailing Address - City:SILAS
Mailing Address - State:AL
Mailing Address - Zip Code:36919-6492
Mailing Address - Country:US
Mailing Address - Phone:251-542-9014
Mailing Address - Fax:
Practice Address - Street 1:1434 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-9602
Practice Address - Country:US
Practice Address - Phone:601-928-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR874544363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner