Provider Demographics
NPI:1245772797
Name:ROGERS, KATRINA (AGACNP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:LIME
Other - Last Name:ECLARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5663 BURNING TREE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4166
Mailing Address - Country:US
Mailing Address - Phone:702-324-1544
Mailing Address - Fax:
Practice Address - Street 1:3270 JOE BATTLE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2639
Practice Address - Country:US
Practice Address - Phone:915-504-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132601363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care