Provider Demographics
NPI:1295499978
Name:ROGERS, KRISTA (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:105 WINDSOR PATH STE 1
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9819
Mailing Address - Country:US
Mailing Address - Phone:859-360-3006
Mailing Address - Fax:
Practice Address - Street 1:105 WINDSOR PATH STE 1
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9819
Practice Address - Country:US
Practice Address - Phone:859-360-3006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1-21-53957103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst