Provider Demographics
NPI:1609894435
Name:ROGERS, MELINDA JANE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:JANE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 BAYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9090
Mailing Address - Country:US
Mailing Address - Phone:317-979-4034
Mailing Address - Fax:317-641-7984
Practice Address - Street 1:11020 PENDLETON PIKE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2817
Practice Address - Country:US
Practice Address - Phone:317-855-6010
Practice Address - Fax:317-826-6281
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000596A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200370950Medicaid
IN715530CDDDMedicare PIN
INM400049655Medicare PIN
IN677700YMedicare PIN
IN220620BBBBMedicare ID - Type Unspecified
IN200370950Medicaid