Provider Demographics
NPI:1043409865
Name:ROGERS, LIBBY LEININGER (ARNP)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:LEININGER
Last Name:ROGERS
Suffix:
Gender:F
Credentials:ARNP
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 751
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-0751
Mailing Address - Country:US
Mailing Address - Phone:918-444-2250
Mailing Address - Fax:918-444-2126
Practice Address - Street 1:529 N. OAK ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2925
Practice Address - Country:US
Practice Address - Phone:918-444-2126
Practice Address - Fax:918-458-2300
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200131110AMedicaid