Basic Information
| Provider Information | |||||||||
| NPI: | 1699843649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | |||||||||
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| Credential: | QBHP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 HIGDON FERRY RD STE D | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719137288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012622766 | ||||||||
| FaxNumber: | 5012622544 | ||||||||
| Practice Location | |||||||||
| Address1: | 2110 HIGDON FERRY RD STE D | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719137288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016239220 | ||||||||
| FaxNumber: | 5016239227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.