Provider Demographics
NPI:1356671408
Name:ROGERS, KIMBERLY JONES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JONES
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MICHELLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:200 GROVE PARK LN STE 212
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5944
Mailing Address - Country:US
Mailing Address - Phone:334-714-6234
Mailing Address - Fax:334-819-1987
Practice Address - Street 1:200 GROVE PARK LN STE 212
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305
Practice Address - Country:US
Practice Address - Phone:334-714-6234
Practice Address - Fax:334-819-1987
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1587103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist