Provider Demographics
NPI:1831841667
Name:ROGERS, JACQUELINE YVETTE (RN BSN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:YVETTE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 PHYLLIS CT
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6216
Mailing Address - Country:US
Mailing Address - Phone:706-589-3100
Mailing Address - Fax:
Practice Address - Street 1:3616 PHYLLIS CT
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-6216
Practice Address - Country:US
Practice Address - Phone:706-589-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9455912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse