MEDICARE: JULIE ROGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	201903391	OR
2	363L00000X	Nurse Practitioner	201903391NP-PP	OR
3	363LF0000X	Family Nurse Practitioner	AP126742	TX

General Provider Information

NPI Number	:	1083002851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ROGERS

Provider Business Mailing Address
First Line	:	4118 POND HILL RD STE 300
Second Line	:
City	:	SHAVANO PARK
State	:	TX
Zip	:	78231-1282
Country	:	US
Telephone Number	:	210-494-3739
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 POND HILL RD STE 300
Second Line	:
City	:	SHAVANO PARK
State	:	TX
Zip	:	78231-1282
Country	:	US
Telephone Number	:	210-494-3739
Fax Number	:	210-494-4508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2015
Last Update Date	:	05/12/2023

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