Provider Demographics
NPI:1053300665
Name:ROGERS, KIMBERLY PERRY (NP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:PERRY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7291
Mailing Address - Country:US
Mailing Address - Phone:410-572-8848
Mailing Address - Fax:410-572-6890
Practice Address - Street 1:1415 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7291
Practice Address - Country:US
Practice Address - Phone:410-572-8848
Practice Address - Fax:410-912-7234
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001686363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner