Provider Demographics
NPI:1427549377
Name:ROGERS, CRYSTAL GAIL (FNP-C)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:GAIL
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2761
Mailing Address - Country:US
Mailing Address - Phone:865-262-0049
Mailing Address - Fax:865-262-0106
Practice Address - Street 1:1338 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2761
Practice Address - Country:US
Practice Address - Phone:865-262-0049
Practice Address - Fax:865-262-0106
Is Sole Proprietor?:No
Enumeration Date:2018-05-27
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN206388163W00000X, 363LA2100X
TN24364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care