Provider Demographics
NPI:1407135163
Name:ROGERS, KIM ANN
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 WS HWY 154
Mailing Address - Street 2:
Mailing Address - City:VETERAN
Mailing Address - State:WY
Mailing Address - Zip Code:82243
Mailing Address - Country:US
Mailing Address - Phone:307-620-1798
Mailing Address - Fax:
Practice Address - Street 1:2959 WS HWY 154
Practice Address - Street 2:
Practice Address - City:VETERAN
Practice Address - State:WY
Practice Address - Zip Code:82243
Practice Address - Country:US
Practice Address - Phone:307-620-1798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services