Provider Demographics
NPI:1295490191
Name:ROGERS, KATELYN SUZANNE (RNC)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:SUZANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 TREADWELL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9229
Mailing Address - Country:US
Mailing Address - Phone:843-810-3473
Mailing Address - Fax:
Practice Address - Street 1:1041 JOHNNIE DODDS BLVD STE 14B
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6156
Practice Address - Country:US
Practice Address - Phone:843-509-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225805163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant