Provider Demographics
NPI:1821450875
Name:ROGERS, JESSICA (RN, MSN, ACAGNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, MSN, ACAGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 OLD HIGHWAY RD
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:TX
Mailing Address - Zip Code:77968-3676
Mailing Address - Country:US
Mailing Address - Phone:361-935-6771
Mailing Address - Fax:
Practice Address - Street 1:506 E SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6060
Practice Address - Country:US
Practice Address - Phone:361-935-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130615363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care