Provider Demographics
NPI:1902287295
Name:MYRICK, CHRISTY DARLINE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:DARLINE
Last Name:MYRICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:CHRISTY
Other - Middle Name:DARLINE
Other - Last Name:GIST-SWEAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 2895
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-2895
Mailing Address - Country:US
Mailing Address - Phone:256-735-5071
Mailing Address - Fax:256-801-7626
Practice Address - Street 1:1549 HIGHWAY 31 NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-4431
Practice Address - Country:US
Practice Address - Phone:256-735-5920
Practice Address - Fax:256-678-7710
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105765363LW0102X, 363LX0106X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL177651Medicaid
AL177651Medicaid