Healthcare Provider Details

I. General information

NPI: 1538927009
Provider Name (Legal Business Name): CRYSTAL J ROGERS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 1ST ST
SWEETWATER TX
79556-4654
US

IV. Provider business mailing address

301 SE 3RD ST
KNOX CITY TX
79529-2067
US

V. Phone/Fax

Practice location:
  • Phone: 325-842-7235
  • Fax: 325-842-7283
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1154918
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: