Provider Demographics
NPI:1891240974
Name:ROGERS, CHARITY (RD)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CHRISTIE DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5549
Mailing Address - Country:US
Mailing Address - Phone:936-699-5433
Mailing Address - Fax:936-699-5465
Practice Address - Street 1:203 CHRISTIE DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5549
Practice Address - Country:US
Practice Address - Phone:936-699-5433
Practice Address - Fax:936-699-5465
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86053648133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered