Provider Demographics
NPI:1194262436
Name:RODGERS, ANNE TUCKER (PA-C)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:TUCKER
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4337
Mailing Address - Country:US
Mailing Address - Phone:252-673-2436
Mailing Address - Fax:
Practice Address - Street 1:808 SCHENCK ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3934
Practice Address - Country:US
Practice Address - Phone:704-480-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant