Provider Demographics
NPI:1295830131
Name:ROGERS, SUZANNE B (FNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4877
Mailing Address - Country:US
Mailing Address - Phone:423-929-2584
Mailing Address - Fax:423-722-2060
Practice Address - Street 1:401 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4877
Practice Address - Country:US
Practice Address - Phone:423-929-2584
Practice Address - Fax:423-722-2060
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12112363LF0000X
VAAPN0024169684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ74151Medicare UPIN
TN3644429Medicare ID - Type Unspecified