Individual
MISS TARA NICOLE ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
505 E DAVE WARD DR, CONWAY, AR 72032-7825
(501) 500-3500
(501) 904-3620
Mailing address
800 FAIR PARK BLVD, LITTLE ROCK, AR 72204-1720
(501) 404-8007
(501) 904-3620
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-513
AR
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA513
LICENSE
AR
Enumeration date
10/20/2010
Last updated
12/13/2024
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