Provider Demographics
NPI:1356196976
Name:ROGERS, RILEY CLAY
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:CLAY
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3392 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:HOKES BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35903-7611
Mailing Address - Country:US
Mailing Address - Phone:256-458-1833
Mailing Address - Fax:
Practice Address - Street 1:1007 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1100
Practice Address - Country:US
Practice Address - Phone:256-494-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-170977363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health