Provider Demographics
NPI:1588734859
Name:ROGERS, KERRY JEANNE
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:JEANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:JEANNE
Other - Last Name:HEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:279 CASTLE HILL RANCH RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2738
Mailing Address - Country:US
Mailing Address - Phone:925-935-9563
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT EXT
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4303
Practice Address - Country:US
Practice Address - Phone:510-642-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5428OtherNP FURNISHING NUMBER
CAMR0581290OtherDEA NUMBER