Provider Demographics
NPI:1568075992
Name:RODGERS, RANDI (APRN)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ATHENA CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-5906
Mailing Address - Country:US
Mailing Address - Phone:501-240-5064
Mailing Address - Fax:
Practice Address - Street 1:8201 CANTRELL RD STE 265
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2347
Practice Address - Country:US
Practice Address - Phone:501-661-0077
Practice Address - Fax:501-664-2749
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR212814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily