Provider Demographics
NPI:1649549858
Name:ROGERS, VIVIAN ANN (NP)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:408 COUNCIL CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4949
Mailing Address - Country:US
Mailing Address - Phone:662-377-6332
Mailing Address - Fax:662-377-6330
Practice Address - Street 1:408 COUNCIL CIR
Practice Address - Street 2:SUITE C
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4949
Practice Address - Country:US
Practice Address - Phone:662-377-6332
Practice Address - Fax:662-377-6330
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR866554363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health