Provider Demographics
NPI:1164634861
Name:ROGERS, TERESA A (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BRANNON LN
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-5850
Mailing Address - Country:US
Mailing Address - Phone:423-338-4533
Mailing Address - Fax:
Practice Address - Street 1:2279 PARKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-3803
Practice Address - Country:US
Practice Address - Phone:423-338-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000074330163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health