Individual
KELCIE ANN RODRIGUEZ PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 S FLOYD ST STE 300, LOUISVILLE, KY 40202-1837
(502) 629-1515
(502) 629-1545
Mailing address
8406 OXFORD WOODS CT, LOUISVILLE, KY 40222-4667
(406) 855-6979
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
50082
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000351117
ANTHEM
KY
01
—
230370
SIHO
KY
05
—
300007105
—
IN
01
—
K247810
MEDICARE
KY
Enumeration date
04/09/2013
Last updated
07/08/2021
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