Provider Demographics
NPI:1275009037
Name:ROGERS, LASHAUNDA (APN)
Entity Type:Individual
Prefix:
First Name:LASHAUNDA
Middle Name:
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 1:1264 WESLEY DR STE 501
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6456
Mailing Address - Country:US
Mailing Address - Phone:901-346-1800
Mailing Address - Fax:901-346-0043
Practice Address - Street 1:1264 WESLEY DR STE 501
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6456
Practice Address - Country:US
Practice Address - Phone:901-346-1800
Practice Address - Fax:901-346-0043
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24838363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care