Healthcare Provider Details

I. General information

NPI: 1548396096
Provider Name (Legal Business Name): ROY KENT ROGERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E 8TH ST
BEAVER OK
73932-3184
US

IV. Provider business mailing address

3501 PASQUAL WAY
EDMOND OK
73034-7439
US

V. Phone/Fax

Practice location:
  • Phone: 580-625-4551
  • Fax:
Mailing address:
  • Phone: 580-916-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number812
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: