Provider Demographics
NPI:1871380238
Name:RODGERS, KIMBERLY J (DNP)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:J
Last Name:RODGERS
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1910
Mailing Address - Country:US
Mailing Address - Phone:940-465-5999
Mailing Address - Fax:940-465-5999
Practice Address - Street 1:3435 UNION BLVD
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-1910
Practice Address - Country:US
Practice Address - Phone:940-465-5999
Practice Address - Fax:940-465-5999
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty