Provider Demographics
NPI:1225637564
Name:ROGERS, AMANDA R (APN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CAROLINA BAY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2046
Mailing Address - Country:US
Mailing Address - Phone:910-662-8888
Mailing Address - Fax:
Practice Address - Street 1:510 CAROLINA BAY DR STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2046
Practice Address - Country:US
Practice Address - Phone:910-662-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28361363LP0200X
NC5014365363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics