Provider Demographics
NPI:1609573203
Name:ROGERS, JENNIFER NICOLE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933-9036
Mailing Address - Country:US
Mailing Address - Phone:479-573-3120
Mailing Address - Fax:479-965-2008
Practice Address - Street 1:107 S LOGAN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-9036
Practice Address - Country:US
Practice Address - Phone:479-573-3120
Practice Address - Fax:479-965-2008
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR223441363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR223441OtherAPRN-CNP
ARF01230570OtherAANP CERTIFICATION NUMBER