Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 805416 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | 805416 | TX |
NPI | 1053810127 |
---|---|
Provider Name | Cody Rodriguez |
First Address | Weatherford, TX 76087-2804 |
Second Address | Fort Worth, TX 76132-6115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 09/04/2018 |