Healthcare Provider Details

I. General information

NPI: 1780185264
Provider Name (Legal Business Name): ANGELA ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 KOHLERS XING STE 100
KYLE TX
78640-2473
US

IV. Provider business mailing address

830 KOHLERS XING STE 100
KYLE TX
78640-2473
US

V. Phone/Fax

Practice location:
  • Phone: 512-268-2613
  • Fax: 512-268-2615
Mailing address:
  • Phone: 512-268-2613
  • Fax: 512-268-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1029367
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number738435
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: