Provider Demographics
NPI:1366692055
Name:ROGERS, RAY (RN)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12045 HOMEPORT DR
Mailing Address - Street 2:
Mailing Address - City:MAUREPAS
Mailing Address - State:LA
Mailing Address - Zip Code:70449-3043
Mailing Address - Country:US
Mailing Address - Phone:225-268-1753
Mailing Address - Fax:
Practice Address - Street 1:2550 FLORIDA BLVD SW
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4951
Practice Address - Country:US
Practice Address - Phone:225-667-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN077276163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health