Provider Demographics
NPI:1962959874
Name:ROGERS, CRYSTAL RENEE (CRNP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HONDA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35096
Mailing Address - Country:US
Mailing Address - Phone:205-355-6883
Mailing Address - Fax:205-355-6890
Practice Address - Street 1:1800 HONDA DRIVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35096
Practice Address - Country:US
Practice Address - Phone:205-355-6883
Practice Address - Fax:205-355-6890
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-116246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily