Provider Demographics
NPI:1003401050
Name:DUCKETT, RODNEY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:DUCKETT
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 MELROSE LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2122
Mailing Address - Country:US
Mailing Address - Phone:254-598-0240
Mailing Address - Fax:
Practice Address - Street 1:3605 MELROSE LN
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2122
Practice Address - Country:US
Practice Address - Phone:254-598-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily