Provider Demographics
NPI:1306578414
Name:ROGERS, ZETH THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:ZETH
Middle Name:THOMAS
Last Name:ROGERS
Suffix:
Gender:M
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 1:101 R MILLS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-8329
Mailing Address - Country:US
Mailing Address - Phone:270-405-0689
Mailing Address - Fax:
Practice Address - Street 1:1013 GRANITE DR
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2013
Practice Address - Country:US
Practice Address - Phone:502-349-3100
Practice Address - Fax:502-349-3169
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA3043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant