Provider Demographics
NPI:1083458004
Name:RODRIGUEZ, KENIA JOHANA (FNP)
Entity type:Individual
Prefix:MS
First Name:KENIA
Middle Name:JOHANA
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1647
Mailing Address - Country:US
Mailing Address - Phone:516-660-4322
Mailing Address - Fax:
Practice Address - Street 1:160 E 34TH ST FL 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4744
Practice Address - Country:US
Practice Address - Phone:212-731-6366
Practice Address - Fax:212-731-5527
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353618-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily