Individual provider Active NPI

Kellie Lynn Rogero, FNP

  • Family Nurse Practitioner
  • Dothan, AL
National Provider Identifier
1952148629
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-092914 Issued in AL
Practice address
1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone
(334) 793-8111
NPI assigned
Jul 10, 2024
Last updated
Jul 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1-092914 AL Primary

Addresses

Primary practice location

1108 Ross Clark Cir
Dothan, AL 36301-3022

Mailing address

1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone (334) 618-4024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20241206002883 AL Practitioner - Nurse Practitioner 1557897055 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

102 Doctors Dr
Dothan, AL 36301-2911
Phone (334) 793-6573

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Laboratory Associates Current Accepting new patients
Houston County Healthcare Authority Current Accepting new patients
Houston County Healthcare Authority CurrentSince Sep 1, 2024 Accepting new patients
Houston County Healthcare Authority Current Accepting new patients
Medcore Associates, PLLC Current Accepting new patients
Southeast Alabama Medical Center Employee Pharmacy Past Accepting new patients

Locations

102 Doctors Dr
Dothan, AL 36301
Phone (334) 793-8804

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

Organizations & group practices 6

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.

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": "1720569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1952148629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 ROSS CLARK CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013022",
            "telephone_number": "334-618-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 ROSS CLARK CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013022",
            "telephone_number": "334-793-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERO",
        "first_name": "KELLIE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-092914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.