Provider Demographics
NPI:1053981647
Name:ROGERS, SCOTT DOUGLAS (FNP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DOUGLAS
Last Name:ROGERS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WILLIAMSBURG CIR APT A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6174
Mailing Address - Country:US
Mailing Address - Phone:337-417-0892
Mailing Address - Fax:
Practice Address - Street 1:108 RUE LOUIS XIV
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5739
Practice Address - Country:US
Practice Address - Phone:337-235-8007
Practice Address - Fax:337-235-8008
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06212165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily