Provider Demographics
NPI:1215634340
Name:ROGE-JONES, KATHERINE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:ROGE-JONES
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 1:716 GOODLET CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8332
Mailing Address - Country:US
Mailing Address - Phone:712-223-0163
Mailing Address - Fax:
Practice Address - Street 1:716 GOODLET CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-8332
Practice Address - Country:US
Practice Address - Phone:712-223-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant