Provider Demographics
NPI:1053953521
Name:ROGERS, JASON (AGNP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11988 BLACK HAWK DR
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7140
Mailing Address - Country:US
Mailing Address - Phone:303-949-7632
Mailing Address - Fax:
Practice Address - Street 1:11988 BLACK HAWK DR
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7140
Practice Address - Country:US
Practice Address - Phone:303-949-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995042-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health