Provider Demographics
NPI:1568000214
Name:ROGERS, KRISTY MINOR (DNP, APRN, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:MINOR
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 YELLOWHORN TRL
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6102
Mailing Address - Country:US
Mailing Address - Phone:704-649-8286
Mailing Address - Fax:
Practice Address - Street 1:2607 W ARROWOOD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6134
Practice Address - Country:US
Practice Address - Phone:704-588-0232
Practice Address - Fax:704-588-0445
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189132363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics