Provider Demographics
NPI:1063434470
Name:ROGERS, CATHY ANN LEAKE (CRNA)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN LEAKE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8700
Mailing Address - Country:US
Mailing Address - Phone:575-443-7565
Mailing Address - Fax:
Practice Address - Street 1:1528 VICTORIA GREEN BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-5986
Practice Address - Country:US
Practice Address - Phone:812-454-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX530355367500000X
IN28151018A367500000X
OR10020234367500000X
KY3572A367500000X
MO2001018353367500000X
NMCRNA-66208367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1174541981OtherNEWBURGH ANESTHESIA ASSOCIATES, LLC GROUP NPI #
IN200374720AMedicaid
IN200374720AMedicaid
INR79048Medicare UPIN