MEDICARE: MR. AUSTIN TYLER ROGERS FNP

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	2026009856	MO

General Provider Information

NPI Number	:	1912855636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUSTIN TYLER ROGERS FNP

Provider Business Mailing Address
First Line	:	7877 WILLOW CHASE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5934
Country	:	US
Telephone Number	:	832-869-4818
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 S MARKET AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65806-2026
Country	:	US
Telephone Number	:	832-869-4818
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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