Provider Demographics
NPI:1558788992
Name:ROGERS, CYNTHIA RENA (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:950 SKIPPERVILLE ROAD
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-0823
Mailing Address - Country:US
Mailing Address - Phone:706-537-1657
Mailing Address - Fax:
Practice Address - Street 1:601 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3619
Practice Address - Country:US
Practice Address - Phone:505-727-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN161745163W00000X
AL1-128304163W00000X
FL9315690163W00000X
GARN188422363LA2100X
NMCNP 02405363LA2100X
NMRN 79494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse