Healthcare Provider Details

I. General information

NPI: 1801843636
Provider Name (Legal Business Name): JANA L RODDY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 82ND ST
LUBBOCK TX
79423-1900
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 133
LUBBOCK TX
79407-3544
US

V. Phone/Fax

Practice location:
  • Phone: 806-722-3180
  • Fax: 806-722-3185
Mailing address:
  • Phone: 806-785-2045
  • Fax: 806-785-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number246698
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: