Provider Demographics
NPI:1659604536
Name:RODGERS, VONNIE L (NP)
Entity Type:Individual
Prefix:
First Name:VONNIE
Middle Name:L
Last Name:RODGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-238-2801
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 221
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-897-7107
Practice Address - Fax:502-897-7613
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2014-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK66498363L00000X
KY3009057363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner