Provider Demographics
NPI:1649371113
Name:ROGERS, JOHN A JR (ARNP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 OUTLOOK RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-9202
Mailing Address - Country:US
Mailing Address - Phone:509-837-1676
Mailing Address - Fax:509-837-1992
Practice Address - Street 1:3920 OUTLOOK RD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-9202
Practice Address - Country:US
Practice Address - Phone:509-837-1676
Practice Address - Fax:509-837-1992
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9647157Medicaid
WAQ47848Medicare UPIN