Provider Demographics
NPI:1316829500
Name:ROGERSON, STACY (CRNP, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:ROGERSON
Suffix:
Gender:F
Credentials:CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4116
Mailing Address - Country:US
Mailing Address - Phone:724-880-8809
Mailing Address - Fax:
Practice Address - Street 1:95 ENTERPRISE ST STE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2070
Practice Address - Country:US
Practice Address - Phone:724-880-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP033403363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health