Provider Demographics
NPI:1801843636
Name:RODDY, JANA L (NP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:L
Last Name:RODDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY STE 133
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-785-2045
Mailing Address - Fax:806-785-0872
Practice Address - Street 1:4004 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1900
Practice Address - Country:US
Practice Address - Phone:806-722-3180
Practice Address - Fax:806-722-3185
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX246698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94872589Medicaid
TXQ23632Medicare UPIN
NM94872589Medicaid