Provider Demographics
NPI:1518158393
Name:ROGERS, JAMIE LEIGH (PHD, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LEIGH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PHD, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610A OLD TAR VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7936
Mailing Address - Country:US
Mailing Address - Phone:252-364-8972
Mailing Address - Fax:
Practice Address - Street 1:610A OLD TAR VILLAGE RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7936
Practice Address - Country:US
Practice Address - Phone:252-364-8972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32153363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health