Provider Demographics
NPI:1083002851
Name:ROGERS, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 POND HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1282
Mailing Address - Country:US
Mailing Address - Phone:210-494-3739
Mailing Address - Fax:
Practice Address - Street 1:4118 POND HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1282
Practice Address - Country:US
Practice Address - Phone:210-494-3739
Practice Address - Fax:210-494-4508
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201903391363L00000X
OR201903391NP-PP363L00000X
TXAP126742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner