Provider Demographics
NPI:1407741614
Name:ROGERS, STEPHANIE R (PMHNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 UPPER TRENT WAY
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9411
Mailing Address - Country:US
Mailing Address - Phone:937-241-4354
Mailing Address - Fax:937-241-4354
Practice Address - Street 1:2338 UPPER TRENT WAY
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9411
Practice Address - Country:US
Practice Address - Phone:937-241-4354
Practice Address - Fax:937-241-4354
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.325261163W00000X
OHLE-00057009363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse