Provider Demographics
NPI:1154158145
Name:ROGERS, TAMMY JO (BSN, RN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:ROGERS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:JO
Other - Last Name:GRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:128 CHAPEL LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9069
Mailing Address - Country:US
Mailing Address - Phone:423-339-7294
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST STE 180
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2027
Practice Address - Country:US
Practice Address - Phone:601-414-0484
Practice Address - Fax:601-500-5060
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse