Provider Demographics
NPI:1295244192
Name:ROGERS, CANDACE G (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:G
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. WHITESTONE BLVD
Mailing Address - Street 2:SUITE 148-123
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6902
Mailing Address - Country:US
Mailing Address - Phone:316-200-5621
Mailing Address - Fax:
Practice Address - Street 1:100 E. WHITESTONE BLVD
Practice Address - Street 2:SUITE 148-123
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6902
Practice Address - Country:US
Practice Address - Phone:316-200-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily