Individual
SUSAN NELL ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
3370 S TEXAS AVE, #B, BRYAN, TX 77802-3127
(979) 595-1700
(979) 595-1740
Mailing address
1500 UNIVERSITY DR E, #100, COLLEGE STATION, TX 77840-2600
(979) 846-1100
(979) 260-9390
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
231641
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000951607
—
TX
05
—
154467801
—
TX
01
—
1649265646
NPI CLINIC B
TX
01
—
1821185299
NPI AGENCY
TX
05
—
187842301
—
TX
01
—
231641
TEXAS BOARD NURSING
TX
01
—
741715140
TAX ID
TX
Enumeration date
08/21/2006
Last updated
07/10/2013
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