Provider Demographics
NPI:1356781124
Name:ROGERS, RYAN K (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:K
Last Name:ROGERS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SHAVER DR
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8552
Mailing Address - Country:US
Mailing Address - Phone:423-581-7040
Mailing Address - Fax:423-581-9563
Practice Address - Street 1:204 SHAVER DR
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8552
Practice Address - Country:US
Practice Address - Phone:423-581-7040
Practice Address - Fax:423-581-9563
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN160679163W00000X
TNAPN17666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000929Medicaid
TNQ000929Medicaid