Provider Demographics
NPI:1750052072
Name:RODGERS, KRISTINA MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 BILL WALLACE DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37737-2558
Mailing Address - Country:US
Mailing Address - Phone:865-809-4556
Mailing Address - Fax:
Practice Address - Street 1:8930 CROSS PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4713
Practice Address - Country:US
Practice Address - Phone:423-271-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily