Provider Demographics
NPI:1144203696
Name:ROGERS, CHRISTINA P (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:P
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:PAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:158 MEMORIAL CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6322
Mailing Address - Country:US
Mailing Address - Phone:910-937-0008
Mailing Address - Fax:910-937-0098
Practice Address - Street 1:461 WESTERN BLVD STE 122
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7637
Practice Address - Country:US
Practice Address - Phone:910-333-0283
Practice Address - Fax:910-333-0513
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04360363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1144203696Medicaid
P00408200OtherMEDICARE RAILROAD
VA010136652Medicaid
VA010136652Medicaid
013959L84Medicare PIN
Q40813Medicare UPIN