Provider Demographics
NPI:1649767476
Name:ROGERS, KATIE ROSE (NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ROSE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ROSE
Other - Last Name:SHAWCROFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24091 NOVIA CIR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4334
Mailing Address - Country:US
Mailing Address - Phone:801-885-4678
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 351
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6374
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008536363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care