MEDICARE: KRISTINA MICHELLE RODGERS FNP-BC

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	30472	TN

General Provider Information

NPI Number	:	1750052072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MICHELLE RODGERS FNP-BC

Provider Business Mailing Address
First Line	:	1242 BILL WALLACE DR
Second Line	:
City	:	FRIENDSVILLE
State	:	TN
Zip	:	37737-2558
Country	:	US
Telephone Number	:	865-809-4556
Fax Number	:

Provider Business Practice Location Address
First Line	:	8930 CROSS PARK DR STE 3
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4713
Country	:	US
Telephone Number	:	423-271-9911
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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