Individual
KENNETH ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 BOW ST STE A, FAYETTEVILLE, NC 28301-2308
(919) 675-6549
Mailing address
122 BOW ST STE A, FAYETTEVILLE, NC 28301-2308
(919) 675-6549
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
2015213901
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51144
DWI FACILITY CODE
NC
Enumeration date
02/04/2015
Last updated
02/04/2015
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