Provider Demographics
NPI:1528504644
Name:ROGERS, CHARLES DARREN (FNP-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DARREN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 EMILY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-8385
Mailing Address - Country:US
Mailing Address - Phone:606-923-5769
Mailing Address - Fax:
Practice Address - Street 1:6214 EMILY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-8385
Practice Address - Country:US
Practice Address - Phone:606-923-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily