Provider Demographics
NPI:1023460623
Name:RODROCK, NICHOLE J (CNP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:J
Last Name:RODROCK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18598 BUSINESS 13
Mailing Address - Street 2:
Mailing Address - City:BRANSON WEST
Mailing Address - State:MO
Mailing Address - Zip Code:65737-9659
Mailing Address - Country:US
Mailing Address - Phone:417-272-8497
Mailing Address - Fax:
Practice Address - Street 1:18598 BUSINESS 13
Practice Address - Street 2:
Practice Address - City:BRANSON WEST
Practice Address - State:MO
Practice Address - Zip Code:65737-9659
Practice Address - Country:US
Practice Address - Phone:417-272-8497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily