Provider Demographics
NPI:1568543817
Name:ROGERS, MISTY (NP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 UNICORN LAKE BLVD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-387-6248
Mailing Address - Fax:940-381-1881
Practice Address - Street 1:3321 UNICORN LAKE BLVD
Practice Address - Street 2:SUITE 121
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-387-6248
Practice Address - Fax:940-381-1881
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX657510363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health