Provider Demographics
NPI:1134504426
Name:ROGERS, SIOBAIN KAY (MSN, FNP-C, CCRN)
Entity Type:Individual
Prefix:MRS
First Name:SIOBAIN
Middle Name:KAY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSN, FNP-C, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-7600
Mailing Address - Country:US
Mailing Address - Phone:409-296-6000
Mailing Address - Fax:
Practice Address - Street 1:85 IH 10 N STE 112
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2560
Practice Address - Country:US
Practice Address - Phone:409-239-5139
Practice Address - Fax:409-347-8856
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204428363L00000X
NDR45403363LF0000X
TX781923363LF0000X
TXAP130283363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398668902Medicaid
TXCVDB81OtherMEDICARE