Basic Information
| Provider Information | |||||||||
| NPI: | 1104816925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHODES | ||||||||
| FirstName: | AUDRY | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D., M.S., FAAFP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23229 | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423043229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706881330 | ||||||||
| FaxNumber: | 2706881338 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 MAYFAIR DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423014568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706881352 | ||||||||
| FaxNumber: | 2706834313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01058040A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 26465 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 2083P0500X | 26465 | KY | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | 2083X0100X | 26465 | KY | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200466230 | 05 | IN | MEDICAID | 000000566966 | 01 | KY | CHS ANTHEM PIN | OTHER | 7100042640 | 05 | KY | MEDICAID |