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NPI Code Detail

MEDICARE: KELLY RENAY RODGERS

MEDICARE: KELLY RENAY RODGERS
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
1106S00000XBehavior TechnicianRBT-24-320608TX

General Provider Information

NPI Number : 1467222794
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RENAY RODGERS
Provider Business Mailing Address
First Line : 107 N ASHFORD ST
Second Line :
City : SAVOY
State : TX
Zip : 75479-2301
Country : US
Telephone Number : 903-805-8744
Fax Number :
Provider Business Practice Location Address
First Line : 2612 W LAMBERTH RD
Second Line :
City : SHERMAN
State : TX
Zip : 75092-5179
Country : US
Telephone Number : 254-249-6530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2024
Last Update Date : 02/11/2025

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Directions to “ KELLY RENAY RODGERS ” Practice Location

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