1902287295 NPI number — MRS. CHRISTY DARLINE MYRICK CRNP

Table of content: JESSICA WINKLER (NPI 1730857335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902287295 NPI number — MRS. CHRISTY DARLINE MYRICK CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYRICK
Provider First Name:
CHRISTY
Provider Middle Name:
DARLINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIST-SWEAT
Provider Other First Name:
CHRISTY
Provider Other Middle Name:
DARLINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902287295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2895
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULLMAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35056-2895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-735-5071
Provider Business Mailing Address Fax Number:
256-801-7626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1635 HIGHWAY 31 NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTSELLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35640-4481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-735-5900
Provider Business Practice Location Address Fax Number:
256-417-4719
Provider Enumeration Date:
06/12/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  1-105765 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0106X , with the licence number: 1-105765 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: 1-105765 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 1-105765 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)