Provider Demographics
NPI:1225389364
Name:RODGERS, KRISTI ANN
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:ANN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-6601
Mailing Address - Country:US
Mailing Address - Phone:541-922-0880
Mailing Address - Fax:541-922-2820
Practice Address - Street 1:290 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882-6601
Practice Address - Country:US
Practice Address - Phone:541-701-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
OR23-QMHA-II-000182171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker