Provider Demographics
NPI:1710146311
Name:ROGERS, BRENDA JOY (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JOY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 RIVER OAKS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9500
Mailing Address - Country:US
Mailing Address - Phone:601-932-7005
Mailing Address - Fax:601-932-7156
Practice Address - Street 1:1020 RIVER OAKS DR
Practice Address - Street 2:STE 110
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9500
Practice Address - Country:US
Practice Address - Phone:601-932-7005
Practice Address - Fax:601-932-7156
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851232163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse