MEDICARE: JACQUELINE ROGERS APRN-BC

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	363LF0000X	Family Nurse Practitioner	1156829	TX

General Provider Information

NPI Number	:	1629505508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ROGERS APRN-BC

Provider Business Mailing Address
First Line	:	8035 E R L THORNTON FWY STE 235
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-7037
Country	:	US
Telephone Number	:	214-427-0934
Fax Number	:	214-389-2355

Provider Business Practice Location Address
First Line	:	8035 E R L THORNTON FWY STE 235
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-7037
Country	:	US
Telephone Number	:	214-427-0934
Fax Number	:	214-389-2355

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

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	02/02/2026

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