Basic Information
| Provider Information | |||||||||
| NPI: | 1801843636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODDY | ||||||||
| FirstName: | JANA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5219 CITY BANK PKWY STE 133 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794073544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067852045 | ||||||||
| FaxNumber: | 8067850872 | ||||||||
| Practice Location | |||||||||
| Address1: | 4004 82ND ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794231900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067223180 | ||||||||
| FaxNumber: | 8067223185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 246698 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 94872589 | 05 | NM | MEDICAID |