Provider Demographics
NPI:1700899903
Name:ROGERS-JOHNSON, ALICE MAE (RNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:MAE
Last Name:ROGERS-JOHNSON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 PINE ST
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:AR
Mailing Address - Zip Code:71640-2137
Mailing Address - Country:US
Mailing Address - Phone:870-355-2477
Mailing Address - Fax:
Practice Address - Street 1:1742 S HIGHWAY 65 82
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1560
Practice Address - Country:US
Practice Address - Phone:870-265-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1052363LP0200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health