Provider Demographics
NPI:1508854209
Name:ROGERS, ROBERT T (APRN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:ROGERS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:STE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-587-8306
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:502-587-8306
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99008560A363LA2100X
IN71001726A363LA2100X
KY3003766363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500025402OtherRAILROAD MEDICARE
KY500025250OtherRAILROAD MEDICARE
IN200470800Medicaid
KY78007721Medicaid
KY0640905Medicare PIN
KY00314016Medicare PIN
KY00313016Medicare PIN
KY00309016Medicare PIN
KY78007721Medicaid
KY1273221Medicare PIN
KY0618324Medicare PIN
KY0690817Medicare PIN
IN126930UMedicare PIN
IN228550RMedicare PIN
IN251440BMedicare PIN
KY00311016Medicare PIN
KY00312016Medicare PIN
IN200470800Medicaid
KY00546085Medicare Oscar/Certification
KY00310016Medicare PIN
KY0289317Medicare PIN
KYP00632801Medicare PIN
KY00308016Medicare PIN