Provider Demographics
NPI:1306365358
Name:ROGERS, AMANDA JAYNE (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JAYNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 PLATEAU DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-9246
Mailing Address - Country:US
Mailing Address - Phone:903-826-0945
Mailing Address - Fax:
Practice Address - Street 1:3500 SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2950
Practice Address - Country:US
Practice Address - Phone:501-955-5589
Practice Address - Fax:501-955-5960
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005267363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care