Provider Demographics
NPI:1376207886
Name:ROGERS, KAITLYN ELDRIDGE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELDRIDGE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6873
Mailing Address - Country:US
Mailing Address - Phone:423-443-8569
Mailing Address - Fax:
Practice Address - Street 1:5151 HIGH ST
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6873
Practice Address - Country:US
Practice Address - Phone:423-443-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily