Provider Demographics
NPI:1740648880
Name:ROGERS, BRANDIE (FNP-C)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1042 WILLOW CREEK RD STE A101 #222
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-237-4422
Mailing Address - Fax:
Practice Address - Street 1:3105 CLEARWATER DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7166
Practice Address - Country:US
Practice Address - Phone:928-237-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN164322163W00000X
AZAP8454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse