Provider Demographics
NPI:1790478915
Name:ROGAN, KATHLEEN MARJORIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARJORIE
Last Name:ROGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 15TH ST NE
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:ND
Mailing Address - Zip Code:58278-9251
Mailing Address - Country:US
Mailing Address - Phone:507-339-8574
Mailing Address - Fax:
Practice Address - Street 1:1200 ROBERTS AVE NE
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:ND
Practice Address - Zip Code:58425-7101
Practice Address - Country:US
Practice Address - Phone:701-786-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR44511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily