Provider Demographics
NPI:1023280419
Name:ROGERS, ELIZABETH STILES (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STILES
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:STILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 S COULTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1787
Mailing Address - Country:US
Mailing Address - Phone:806-354-0404
Mailing Address - Fax:
Practice Address - Street 1:1500 S COULTER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1791
Practice Address - Country:US
Practice Address - Phone:806-354-0404
Practice Address - Fax:806-354-2810
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630997363LP0200X
TXAP116685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95287710Medicaid
TX198958403Medicaid