Provider Demographics
NPI:1538737010
Name:CROSSROADS FAMILY CLINIC, LLC
Entity type:Organization
Organization Name:CROSSROADS FAMILY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:TENNELL
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-443-3171
Mailing Address - Street 1:75 COUNTY ROAD 576
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652
Mailing Address - Country:US
Mailing Address - Phone:256-443-3171
Mailing Address - Fax:
Practice Address - Street 1:75 COUNTY ROAD 576
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652
Practice Address - Country:US
Practice Address - Phone:256-443-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty