Provider Demographics
NPI:1497795116
Name:ROGERS, SHELLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 BLACK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:40312-9510
Mailing Address - Country:US
Mailing Address - Phone:859-432-2370
Mailing Address - Fax:
Practice Address - Street 1:1520 BOONESBORO RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8816
Practice Address - Country:US
Practice Address - Phone:859-744-0067
Practice Address - Fax:859-744-0042
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY38934OtherLICENSE
KY64111636Medicaid
KY64111636Medicaid
KYP400035959Medicare PIN