Healthcare Provider Details

I. General information

NPI: 1164499372
Provider Name (Legal Business Name): TOMEKA MECHELL ROYSTER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LOOP RD TUSCALOOSA VAMC
TUSCALOOSA AL
35404-5015
US

IV. Provider business mailing address

3701 LOOP RD TUSCALOOSA VAMC
TUSCALOOSA AL
35404-5015
US

V. Phone/Fax

Practice location:
  • Phone: 205-554-2822
  • Fax:
Mailing address:
  • Phone: 205-554-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-095192
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: