Individual provider Active NPI

Brandie Rogers, FNP-C

  • Family Nurse Practitioner
  • Prescott, AZ
National Provider Identifier
1740648880
Registry record updated May 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP8454 Issued in AZ
Practice address
3105 Clearwater Dr Ste a
Prescott, AZ 86305-7166
Phone
(928) 237-4422
NPI assigned
Feb 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN164322 AZ
Family Nurse Practitioner 363LF0000X AP8454 AZ Primary

Addresses

Primary practice location

3105 Clearwater Dr Ste a
Prescott, AZ 86305-7166

Mailing address

1042 Willow Creek Rd Ste A101 #222
Prescott, AZ 86301
Phone (928) 237-4422

Other practice location 1

907 Ainsworth Dr
Prescott, AZ 86305-1607
Phone (928) 777-0070

Other names 1

  • Brandie Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160906000526 AZ Practitioner - Nurse Practitioner 9234425083 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellezza Sensa LLCGroup PAC ID 5294883278, 2 clinicians

Practice addresses (Care Compare)

3105 Clearwater Dr a
Prescott, AZ 86305-7166
Phone (928) 237-4422

Hospital & facility affiliations

  • Yavapai Regional Medical Center Hospital, Prescott, AZ, CCN 030012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN164322AZMDRegistered Nurse
AP8454AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bellezza Sensa LLC CurrentSince Jun 11, 2024 Accepting new patients

Locations

3105 Clearwater Dr
Prescott, AZ 86305
Phone (928) 776-4349

3105 Clearwater Dr
Ste A
Prescott, AZ 86305
Phone (928) 237-4422

1042 Willow Creek Rd
Ste A101
Prescott, AZ 86301

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715385600000",
    "number": "1740648880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1042 WILLOW CREEK RD STE A101 #222",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "86301",
            "telephone_number": "928-237-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 CLEARWATER DR STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057166",
            "telephone_number": "928-237-4422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "907 Ainsworth Dr",
            "address_purpose": "LOCATION",
            "city": "Prescott",
            "state": "AZ",
            "postal_code": "863051607",
            "country_code": "US",
            "telephone_number": "928-777-0070",
            "fax_number": "928-445-7163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "BRANDIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-03",
        "last_updated": "2024-05-11",
        "certification_date": "2024-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN164322",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP8454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDIE",
            "last_name": "CLARK",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.