Provider Demographics
NPI:1245636364
Name:COX, CRYSTAL (RNFA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-5161
Mailing Address - Country:US
Mailing Address - Phone:334-648-1881
Mailing Address - Fax:
Practice Address - Street 1:2800 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2040
Practice Address - Country:US
Practice Address - Phone:334-685-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-088644163WR0006X
FLRN9360638163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant