Provider Demographics
NPI:1962722785
Name:ROGERS, CONSONYA ALECCIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CONSONYA
Middle Name:ALECCIA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DESIARD ST STE 355
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7363
Mailing Address - Country:US
Mailing Address - Phone:183-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:920 OLIVER RD STE 355
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5702
Practice Address - Country:US
Practice Address - Phone:318-807-6258
Practice Address - Fax:318-812-6603
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN124656163W00000X
LAAP203551363L00000X
LA203551363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner