Provider Demographics
NPI:1275976243
Name:RODRIGUEZ PETERSON, KELCIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:KELCIE
Middle Name:ANN
Last Name:RODRIGUEZ PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELCIE
Other - Middle Name:ANN
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8406 OXFORD WOODS CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4667
Mailing Address - Country:US
Mailing Address - Phone:406-855-6979
Mailing Address - Fax:
Practice Address - Street 1:601 S FLOYD ST STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1837
Practice Address - Country:US
Practice Address - Phone:502-629-1515
Practice Address - Fax:502-629-1545
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY50082207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK247810OtherMEDICARE
IN300007105Medicaid
KY00000351117OtherANTHEM
KY230370OtherSIHO