Provider Demographics
NPI:1871905000
Name:ROGERS, KELLI (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:ROTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2361
Mailing Address - Country:US
Mailing Address - Phone:760-572-4176
Mailing Address - Fax:760-572-2117
Practice Address - Street 1:ONE INDIAN HILL RD.
Practice Address - Street 2:
Practice Address - City:WINTERHAVEN
Practice Address - State:CA
Practice Address - Zip Code:92283
Practice Address - Country:US
Practice Address - Phone:760-572-4100
Practice Address - Fax:760-572-2117
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN42390163W00000X
AZTRN1836163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse