Provider Demographics
NPI:1831229236
Name:ROGERS, JACQUELINE L (RD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:L
Other - Last Name:PAGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:725 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1163
Mailing Address - Country:US
Mailing Address - Phone:423-206-9025
Mailing Address - Fax:423-206-9025
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-206-9025
Practice Address - Fax:423-206-9026
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered