Healthcare Provider Details

I. General information

NPI: 1134752975
Provider Name (Legal Business Name): KENDRA RODGERS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 THORNTON TAYLOR PKWY STE C
FAYETTEVILLE TN
37334-3651
US

IV. Provider business mailing address

151 VOEKEL RD
HUNTSVILLE AL
35811-9159
US

V. Phone/Fax

Practice location:
  • Phone: 256-417-2863
  • Fax:
Mailing address:
  • Phone: 256-945-1896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number38148
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: