Individual provider Active NPI

Breanne Nicolle Rogers, CSW

  • Clinical Social Worker
  • Princeton, KY
National Provider Identifier
1841816428
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
257406 Issued in KY
Practice address
1350 US Highway 62 W
Princeton, KY 42445-6106
Phone
(270) 365-2008
NPI assigned
Jun 19, 2020
Last updated
Oct 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 254996 KY
Clinical Social Worker 1041C0700X 257406 KY Primary

Addresses

Primary practice location

1350 US Highway 62 W
Princeton, KY 42445-6106

Mailing address

PO Box 614
Hopkinsville, KY 42241-0614
Phone (270) 886-2205

Other names 1

  • Breanne Ashby Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221103001886 KY Practitioner - Clinical Social Worker 9739556713 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
254996KYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lifeskills, Inc. CurrentSince Jan 17, 2021 Accepting new patients
Lifeskills, Inc. CurrentSince Oct 18, 2022 Accepting new patients

Locations

8324 Eagle Way
Chicago, IL 60678

608 Happy Valley Rd
Glasgow, KY 42141
Phone (270) 651-8379

1350 US Highway 62 W
Princeton, KY 42445
Phone (270) 365-2008

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1841816428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 614",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422410614",
            "telephone_number": "270-886-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 US HIGHWAY 62 W",
            "city": "PRINCETON",
            "state": "KY",
            "postal_code": "424456106",
            "telephone_number": "270-365-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "BREANNE",
        "middle_name": "NICOLLE",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-19",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "254996",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "257406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BREANNE",
            "last_name": "ASHBY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Princeton, KY

Sources for this page

Verify at the official NPI Registry.