Provider Demographics
NPI:1639604317
Name:RODGERS, KENYA (CERT HAIRLOSS SPEC)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CERT HAIRLOSS SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CARAWAY CT
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-5048
Mailing Address - Country:US
Mailing Address - Phone:757-329-5363
Mailing Address - Fax:
Practice Address - Street 1:201 SKYLAND PLZ
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3429
Practice Address - Country:US
Practice Address - Phone:910-568-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAC762221744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management