Provider Demographics
NPI:1710093216
Name:ROGERS, SUSAN NELL (ANP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NELL
Last Name:ROGERS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:#100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:3370 S TEXAS AVE
Practice Address - Street 2:#B
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3127
Practice Address - Country:US
Practice Address - Phone:979-595-1700
Practice Address - Fax:979-595-1740
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX231641363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000951607Medicaid
TX1649265646OtherNPI CLINIC B
TX187842301Medicaid
TX741715140OtherTAX ID
TX1821185299OtherNPI AGENCY
TX154467801Medicaid
TX231641OtherTEXAS BOARD NURSING
TX741715140OtherTAX ID
TX451986Medicare Oscar/Certification
TX154467801Medicaid