Provider Demographics
NPI:1780185264
Name:ROGERS, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 KOHLERS XING STE 100
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2473
Mailing Address - Country:US
Mailing Address - Phone:512-268-2613
Mailing Address - Fax:512-268-2615
Practice Address - Street 1:830 KOHLERS XING STE 100
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-2473
Practice Address - Country:US
Practice Address - Phone:512-268-2613
Practice Address - Fax:512-268-2615
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029367363LF0000X
TX738435163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse