Provider Demographics
NPI:1437465929
Name:ROGERS, BRANDICE A (APN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDICE
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11508 HIGHWAY 49 N
Mailing Address - Street 2:
Mailing Address - City:MARMADUKE
Mailing Address - State:AR
Mailing Address - Zip Code:72443-9558
Mailing Address - Country:US
Mailing Address - Phone:870-597-1319
Mailing Address - Fax:870-597-1320
Practice Address - Street 1:11508 HIGHWAY 49 N
Practice Address - Street 2:
Practice Address - City:MARMADUKE
Practice Address - State:AR
Practice Address - Zip Code:72443-9558
Practice Address - Country:US
Practice Address - Phone:870-597-1319
Practice Address - Fax:870-597-1320
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03412 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186489759Medicaid