MEDICARE: KIMBERLY RODNEY

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1528487444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY RODNEY

Provider Business Mailing Address
First Line	:	11909 BLUE MOON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1014
Country	:	US
Telephone Number	:	405-501-2830
Fax Number	:	405-225-7326

Provider Business Practice Location Address
First Line	:	11909 BLUE MOON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-1014
Country	:	US
Telephone Number	:	405-501-2830
Fax Number	:	405-225-7326

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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Directions to “ KIMBERLY RODNEY ” Practice Location

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