Healthcare Provider Details

I. General information

NPI: 1912855636
Provider Name (Legal Business Name): AUSTIN TYLER ROGERS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 S MARKET AVE
SPRINGFIELD MO
65806-2026
US

IV. Provider business mailing address

7877 WILLOW CHASE BLVD
HOUSTON TX
77070-5934
US

V. Phone/Fax

Practice location:
  • Phone: 832-869-4818
  • Fax:
Mailing address:
  • Phone: 832-869-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026009856
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: