Healthcare Provider Details

I. General information

NPI: 1962322677
Provider Name (Legal Business Name): RODNEY BRANDYN TATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 S UNION ST
KOKOMO IN
46901-6083
US

IV. Provider business mailing address

1717 KENSINGTON ON BERKLEY # 1717
KOKOMO IN
46901-1850
US

V. Phone/Fax

Practice location:
  • Phone: 765-438-0083
  • Fax:
Mailing address:
  • Phone: 424-221-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: