Healthcare Provider Details

I. General information

NPI: 1568543817
Provider Name (Legal Business Name): MISTY ROGERS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 UNICORN LAKE BLVD SUITE 121
DENTON TX
76210
US

IV. Provider business mailing address

3321 UNICORN LAKE BLVD SUITE 121
DENTON TX
76210
US

V. Phone/Fax

Practice location:
  • Phone: 940-387-6248
  • Fax: 940-381-1881
Mailing address:
  • Phone: 940-387-6248
  • Fax: 940-381-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number657510
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: