Provider Demographics
NPI:1871777987
Name:HESS, ROGER A (ANP)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:HESS
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 E VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-9215
Mailing Address - Country:US
Mailing Address - Phone:405-485-9588
Mailing Address - Fax:405-485-3499
Practice Address - Street 1:821 E VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-9215
Practice Address - Country:US
Practice Address - Phone:405-485-9588
Practice Address - Fax:405-485-3499
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0055691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200197510AMedicaid