Provider Demographics
NPI:1740233832
Name:ROGERS, ALICE (FNP)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2093
Mailing Address - Fax:423-390-3340
Practice Address - Street 1:1754 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:WEBER CITY
Practice Address - State:VA
Practice Address - Zip Code:24290
Practice Address - Country:US
Practice Address - Phone:276-386-9771
Practice Address - Fax:276-386-5980
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000058238207Q00000X
TNAPN5728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380594Medicaid
TN1511137Medicaid
TN39056231Medicare PIN
TN1511137Medicaid