Provider Demographics
NPI:1417230004
Name:ROGERS, WHITNEY LEIGH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:LEIGH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:WHITNEY
Other - Middle Name:LEIGH
Other - Last Name:ANKROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1907 W MORRIS BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-3860
Mailing Address - Country:US
Mailing Address - Phone:423-318-0014
Mailing Address - Fax:423-318-2595
Practice Address - Street 1:1907 W MORRIS BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3860
Practice Address - Country:US
Practice Address - Phone:423-318-0014
Practice Address - Fax:423-318-2595
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525717Medicaid
TN103I977124Medicare PIN