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General NPI Number Information
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NPI Number | 1275976243
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Entity Type | Individual
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Provider Name | KELCIE ANN RODRIGUEZ PETERSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 601 S FLOYD ST STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40202-1837
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Country | US
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Telephone | 502-629-1515
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Fax | 502-629-1545
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Provider Business Mailing Address
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Address Line | 8406 OXFORD WOODS CT
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City | LOUISVILLE
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State | KY
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Zip | 40222-4667
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Country | US
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Telephone | 406-855-6979
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 50082
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License Number State | KY
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