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General NPI Number Information
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NPI Number | 1477837326
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Entity Type | Individual
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Provider Name | KIMBERLY ELLEN RODGERS ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1000 1ST DR NW
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City | AUSTIN
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State | MN
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Zip | 55912-2941
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Country | US
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Telephone | 507-433-7351
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 SE 164TH AVE DEPT 358
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City | VANCOUVER
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State | WA
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Zip | 98683-8004
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Country | US
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Telephone | 360-729-1253
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Fax | 360-729-3185
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201910822NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60253433
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License Number State | WA
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