Provider Demographics
NPI:1437749264
Name:ROGERS, WENDY RENEE (APN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:RENEE
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 1:6909 SUGARLAND DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-8176
Mailing Address - Country:US
Mailing Address - Phone:903-277-1328
Mailing Address - Fax:
Practice Address - Street 1:1300 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5567
Practice Address - Country:US
Practice Address - Phone:903-297-1852
Practice Address - Fax:903-234-1639
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214651363LP0808X
TXAP1031606363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health