Provider Demographics
NPI:1194864124
Name:ROY, SUSAN FLEXER (CRNP, FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:FLEXER
Last Name:ROY
Suffix:
Gender:F
Credentials:CRNP, FNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:FLEXER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:705 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4113
Mailing Address - Country:US
Mailing Address - Phone:334-289-0225
Mailing Address - Fax:334-287-0245
Practice Address - Street 1:705 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-4113
Practice Address - Country:US
Practice Address - Phone:334-289-0225
Practice Address - Fax:334-287-0245
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-098539363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA003932OtherAR STATE LICENSE
AL630503108Medicaid
AR5XX70OtherBCBS
AL51536625OtherBLUE CROSS OF ALABAMA
AL51536625OtherBLUE CROSS OF ALABAMA
AR57297Medicare PIN
ARA003932OtherAR STATE LICENSE