Provider Demographics
NPI:1558572446
Name:HOLT-ROGERS, KENDRIA E (MD)
Entity Type:Individual
Prefix:
First Name:KENDRIA
Middle Name:E
Last Name:HOLT-ROGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:504-393-4376
Mailing Address - Fax:
Practice Address - Street 1:501 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7336
Practice Address - Country:US
Practice Address - Phone:504-393-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20682207R00000X
LA204882207R00000X
LAMD.204882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09972039Medicaid
LA2162136Medicaid
LA4Q5407061Medicare PIN