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General NPI Number Information
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NPI Number | 1164984035
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Entity Type | Individual
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Provider Name | CRYSTAL GAYLE SELF CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 2700 10TH AVE S STE 444
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1250
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Country | US
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Telephone | 205-723-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 8434 WADE RD
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City | WARRIOR
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State | AL
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Zip | 35180-3064
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Country | US
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Telephone | 205-543-6251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-105083
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-105083
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License Number State | AL
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