Active NPI
Nicole Rogers
- Periodontics
- Fayetteville, NC
National Provider Identifier
1083300073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 13172
- Practice address
- 612 Winding Creek Rd
Fayetteville, NC 28305-5723 - Phone
- (317) 997-2226
- NPI assigned
- Apr 13, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 13172 | NC | Primary |
Addresses
Primary practice location
612 Winding Creek Rd
Fayetteville, NC 28305-5723
Mailing address
718 E 52ND St
Indianapolis, IN 46205-1120
Phone (317) 997-2226
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13172 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681344000000",
"number": "1083300073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "718 E 52ND ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462051120",
"telephone_number": "317-997-2226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 WINDING CREEK RD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283055723",
"telephone_number": "317-997-2226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROGERS",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-13",
"last_updated": "2023-04-13",
"certification_date": "2023-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NC",
"license": "13172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.