Provider Demographics
NPI:1558319913
Name:ROGERS, AMANDA ELAINE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELAINE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 PARK AVE
Mailing Address - Street 2:210
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3540
Mailing Address - Country:US
Mailing Address - Phone:901-767-6765
Mailing Address - Fax:901-761-4312
Practice Address - Street 1:5220 PARK AVE
Practice Address - Street 2:210
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3540
Practice Address - Country:US
Practice Address - Phone:901-767-6765
Practice Address - Fax:901-761-4312
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily