| Doctor Name: | MS. KELLY N RODGERS |
| NPI Number: | 1063855757 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ACNP-BC |
| License Number: | 730029 |
| Business Practice Address: | 1800 Mormon Mill Rd Bldg B. Ste. 2 Marble Falls, TX - 786544175 |
| Business Phone Number: | 8307982082 |
| Business Fax Number: | 8306930040 |
| Mailing Address: | Po Box 402669, ATLANTA |
| State: | GA |
| Postal Code: | 303842669 |
| Phone Number: | 5122064300 |
| Fax Number: | 5122064350 |
| NPI Enumeration Date: | 04/11/2013 |
| NPI Last Update Date: | 04/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 730029 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |