Basic Information
| Provider Information | |||||||||
| NPI: | 1053300665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | PERRY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 S DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218047291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105728848 | ||||||||
| FaxNumber: | 4105726890 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 S DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218047291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105728848 | ||||||||
| FaxNumber: | 4109127234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AC001686 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.