Provider Demographics
NPI:1205516465
Name:ROGERS, KAYLEE RENA' (APRN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RENA'
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26142 NE CANTON RD
Mailing Address - Street 2:
Mailing Address - City:ALTHA
Mailing Address - State:FL
Mailing Address - Zip Code:32421-3070
Mailing Address - Country:US
Mailing Address - Phone:850-209-4358
Mailing Address - Fax:
Practice Address - Street 1:26142 NE CANTON RD
Practice Address - Street 2:
Practice Address - City:ALTHA
Practice Address - State:FL
Practice Address - Zip Code:32421-3070
Practice Address - Country:US
Practice Address - Phone:850-209-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily