Provider Demographics
NPI:1780215640
Name:ROGERS, AMANDA CABANISS (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CABANISS
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EMERALD CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2107
Mailing Address - Country:US
Mailing Address - Phone:501-940-2666
Mailing Address - Fax:
Practice Address - Street 1:6 EMERALD CT
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2107
Practice Address - Country:US
Practice Address - Phone:501-940-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123565363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health