Provider Demographics
NPI:1124674262
Name:ROGERS, BAILEE LAURYN (PA-C)
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:LAURYN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10719 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3973
Mailing Address - Country:US
Mailing Address - Phone:806-632-8015
Mailing Address - Fax:
Practice Address - Street 1:310 COMAL ST.
Practice Address - Street 2:BLDG A, STE 200, #242
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702
Practice Address - Country:US
Practice Address - Phone:737-270-9500
Practice Address - Fax:833-906-2436
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13948363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program