Individual
JACQUE RENEE ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHPP
Contact information
Practice address
2403 MAIN DR STE 1AND2, FAYETTEVILLE, AR 72704-5223
(479) 249-6379
Mailing address
PO DRAWER 2109, RUSSELLVILLE, AR 72811
(479) 967-2322
(479) 967-2876
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228759795
—
AR
Enumeration date
12/18/2013
Last updated
01/10/2023
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