Provider Demographics
NPI:1083262695
Name:ROGERS, ANDREA MICHELLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 E ROCKHILL ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3919
Mailing Address - Country:US
Mailing Address - Phone:316-221-5545
Mailing Address - Fax:
Practice Address - Street 1:7829 E ROCKHILL ST STE 105
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3919
Practice Address - Country:US
Practice Address - Phone:316-221-5545
Practice Address - Fax:316-221-5546
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78927363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health