Individual
MR. RODERICK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1585 3RD ST, FORT POLK, LA 71459-5102
(337) 531-3011
Mailing address
1509 W LOOP 281 STE 2-B, LONGVIEW, TX 75604-2820
(903) 759-9355
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02232
TX
363A00000X
Physician Assistant
PA200615
LA
Other
Enumeration date
09/11/2006
Last updated
09/16/2025
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