Provider Demographics
NPI:1740561281
Name:ROGERS, KRISTA N (PA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:N
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N 111TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4112
Mailing Address - Country:US
Mailing Address - Phone:262-894-2088
Mailing Address - Fax:
Practice Address - Street 1:2801 W KK RIVER PKWY
Practice Address - Street 2:SUITE 1030
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-908-6500
Practice Address - Fax:414-385-2980
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2784-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant