MEDICARE: DEIRDRA BROWN-RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4046562	KY

General Provider Information

NPI Number	:	1346103397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRA BROWN-RODRIGUEZ

Provider Business Mailing Address
First Line	:	8903 ELI DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8903 ELI DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3190
Country	:	US
Telephone Number	:	516-639-9450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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Directions to “ DEIRDRA BROWN-RODRIGUEZ ” Practice Location

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