| Kenneth F Rodgers Md Pa | |
|
1707 Linwood Drive Suite A Paragould AR 72450 | |
| (870) 236-2202 | |
| (870) 236-8428 |
| Full Name | Kenneth F Rodgers Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1707 Linwood Drive, Paragould, Arkansas |
| Authorized Official Name and Position | Kenneth F Rodgers (OWNER) |
| Authorized Official Contact | 8702362202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth F Rodgers Md Pa 1707 Linwood Drive Suite A Paragould AR 72450 Ph: (870) 236-2202 | Kenneth F Rodgers Md Pa 1707 Linwood Drive Suite A Paragould AR 72450 Ph: (870) 236-2202 |
| NPI Number | 1639351638 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 11/22/2016 |
| Medicare PECOS PAC ID | 8224108493 |
|---|---|
| Medicare Enrollment ID | O20080529000939 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639351638 | NPI | - | NPPES |
| 209217702 | Other | MO | GTE DATA SERVICES MEDICAI |
| 118700001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | C7528 (Arkansas) | Primary |
| Provider Name | Kenneth F Rodgers |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1689633760 PECOS PAC ID: 4587558267 Enrollment ID: I20040212000349 |
| Provider Name | Lacey Shayann Wyatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649358847 PECOS PAC ID: 0244253995 Enrollment ID: I20060109000301 |
| Provider Name | Kelly K. Malone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417173139 PECOS PAC ID: 1456421510 Enrollment ID: I20080531000100 |
| Provider Name | Lacey Jo Songer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609492420 PECOS PAC ID: 4385068329 Enrollment ID: I20200722004038 |
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