Individual
AMY VANDERBECK ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
2809 DENNY AVE, PASCAGOULA, MS 39581-5301
(228) 809-5510
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7576
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
1-107630
AL
363LA2100X
Acute Care Nurse Practitioner
Primary
888068
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03930778
—
MS
Enumeration date
05/13/2011
Last updated
10/13/2017
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