Provider Demographics
NPI:1790118990
Name:ROGERS, KEYSA L
Entity Type:Individual
Prefix:
First Name:KEYSA
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 CAMINO AL NORTE
Mailing Address - Street 2:SUITE 256
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2387
Mailing Address - Country:US
Mailing Address - Phone:702-853-7053
Mailing Address - Fax:702-853-7054
Practice Address - Street 1:5135 CAMINO AL NORTE
Practice Address - Street 2:SUITE 256
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2387
Practice Address - Country:US
Practice Address - Phone:702-853-7053
Practice Address - Fax:702-853-7054
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health