Provider Demographics
NPI:1528644515
Name:DOUGLAS, RODRICKA (PBT(ASCP))
Entity type:Individual
Prefix:
First Name:RODRICKA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PBT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 KONNER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1182
Mailing Address - Country:US
Mailing Address - Phone:859-270-8680
Mailing Address - Fax:
Practice Address - Street 1:1608 KONNER WOODS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1182
Practice Address - Country:US
Practice Address - Phone:859-270-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46954246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy