Provider Demographics
NPI:1730359753
Name:RODGERS, SUZANNE KAY (APN)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:KAY
Last Name:RODGERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30146 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-7864
Mailing Address - Country:US
Mailing Address - Phone:918-647-4243
Mailing Address - Fax:
Practice Address - Street 1:30146 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-7864
Practice Address - Country:US
Practice Address - Phone:918-647-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03358 ANP363LF0000X
OKR63991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily