Provider Demographics
NPI:1275919789
Name:RODRIGUEZ, KENNIE RENE (APRN)
Entity type:Individual
Prefix:MR
First Name:KENNIE
Middle Name:RENE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:60 CROSSVILLE MEDICAL DR STE 109
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4935
Mailing Address - Country:US
Mailing Address - Phone:931-456-3674
Mailing Address - Fax:865-374-2076
Practice Address - Street 1:60 CROSSVILLE MEDICAL DR STE 109
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4935
Practice Address - Country:US
Practice Address - Phone:931-456-3674
Practice Address - Fax:865-374-2076
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2025-06-09
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9212733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ101978Medicaid