Provider Demographics
NPI:1912269390
Name:ROGERS, KALEN G (PA)
Entity Type:Individual
Prefix:MRS
First Name:KALEN
Middle Name:G
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KALEN
Other - Middle Name:LEE
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4451 COUNTRY CLUB RD STE B
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-9255
Mailing Address - Country:US
Mailing Address - Phone:912-871-5437
Mailing Address - Fax:912-623-2037
Practice Address - Street 1:814 TOWNE PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5278
Practice Address - Country:US
Practice Address - Phone:912-303-3560
Practice Address - Fax:912-303-3506
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant