Provider Demographics
NPI:1912370347
Name:ROGERS, PAMELA LEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LEE
Other - Last Name:STICKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2960 TONGASS AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5742
Mailing Address - Country:US
Mailing Address - Phone:907-228-4900
Mailing Address - Fax:800-852-3264
Practice Address - Street 1:240 HOSPITAL PL STE 305
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7559
Practice Address - Country:US
Practice Address - Phone:907-714-4130
Practice Address - Fax:844-412-3946
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016188500Medicaid
FL016188500Medicaid