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General NPI Number Information
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NPI Number | 1124674262
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Entity Type | Individual
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Provider Name | BAILEE LAURYN ROGERS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 310 COMAL ST. BLDG A, STE 200, #242
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City | AUSTIN
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State | TX
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Zip | 78702
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Country | US
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Telephone | 737-270-9500
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Fax | 833-906-2436
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Provider Business Mailing Address
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Address Line | 10719 HURON AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-3973
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Country | US
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Telephone | 806-632-8015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA13948
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License Number State | TX
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