Basic Information
| Provider Information | |||||||||
| NPI: | 1801121165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERS | ||||||||
| FirstName: | JESSI | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPAS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 E 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | TARENTUM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150841003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242242770 | ||||||||
| FaxNumber: | 7242241077 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 E 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | TARENTUM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150841003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242242770 | ||||||||
| FaxNumber: | 7242241077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2009 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 013583 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | OA002571 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | MA054707 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.