Provider Demographics
NPI:1598087942
Name:ROGERSON, BETHANY R (PA-C)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:R
Last Name:ROGERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BROADWAY
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5395
Mailing Address - Country:US
Mailing Address - Phone:206-323-1900
Mailing Address - Fax:206-709-0148
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3595
Practice Address - Country:US
Practice Address - Phone:206-323-1900
Practice Address - Fax:206-323-6868
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60121085363A00000X
363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical