Healthcare Provider Details

I. General information

NPI: 1659604536
Provider Name (Legal Business Name): VONNIE L RODGERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 KRESGE WAY SUITE 221
LOUISVILLE KY
40207-4652
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-7107
  • Fax: 502-897-7613
Mailing address:
  • Phone: 502-238-2801
  • Fax: 502-489-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number66498
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009057
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: