Provider Demographics
NPI:1952581324
Name:ROGERS, KRISTINA BRINKERHOFF (LAC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:BRINKERHOFF
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:SHAYLANA
Other - Middle Name:KRISTINA
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:153 S LYNX CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:223 E UNION ST STE 2
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3806
Practice Address - Country:US
Practice Address - Phone:928-848-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ74171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist