Provider Demographics
NPI:1114628617
Name:RODRIGUEZ, KRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-0308
Mailing Address - Country:US
Mailing Address - Phone:423-338-8995
Mailing Address - Fax:423-338-8996
Practice Address - Street 1:2020 WESTLAND DR SW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-8163
Practice Address - Country:US
Practice Address - Phone:423-478-1970
Practice Address - Fax:423-614-5270
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily