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General NPI Number Information
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NPI Number | 1275919789
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Entity Type | Individual
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Provider Name | KENNIE RENE RODRIGUEZ APRN
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Gender | Male
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 60 CROSSVILLE MEDICAL DR STE 109
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City | CROSSVILLE
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State | TN
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Zip | 38555-4935
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Country | US
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Telephone | 931-456-3674
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Fax | 865-374-2076
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Provider Business Mailing Address
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Address Line | 60 CROSSVILLE MEDICAL DR STE 109
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City | CROSSVILLE
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State | TN
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Zip | 38555-4935
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Country | US
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Telephone | 931-456-3674
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Fax | 865-374-2076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9212733
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License Number State | FL
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