Provider Demographics
NPI:1437417482
Name:ROGERS, KATHLEEN E (FNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:E
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8209 SE 138TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236
Mailing Address - Country:US
Mailing Address - Phone:707-834-1820
Mailing Address - Fax:
Practice Address - Street 1:8209 SE 138TH DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-7209
Practice Address - Country:US
Practice Address - Phone:707-834-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201140186RN163W00000X
OR201150007NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse