Provider Demographics
NPI:1700211687
Name:RODRIGUEZ, KENDALL A (PA)
Entity Type:Individual
Prefix:MS
First Name:KENDALL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:A
Other - Last Name:WELKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1028 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45459-6700
Mailing Address - Country:US
Mailing Address - Phone:937-425-4020
Mailing Address - Fax:937-425-4029
Practice Address - Street 1:244 WILSON DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385
Practice Address - Country:US
Practice Address - Phone:937-372-1602
Practice Address - Fax:937-372-0154
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003871RX363A00000X
OH363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical