1194864124 NPI number — SUSAN FLEXER ROY CRNP, FNP

Table of content: SUSAN FLEXER ROY CRNP, FNP (NPI 1194864124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194864124 NPI number — SUSAN FLEXER ROY CRNP, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
SUSAN
Provider Middle Name:
FLEXER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLEXER
Provider Other First Name:
SUSAN
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194864124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 US HIGHWAY 80 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEMOPOLIS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36732-4113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-289-0225
Provider Business Mailing Address Fax Number:
334-287-0245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 US HIGHWAY 80 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEMOPOLIS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36732-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-289-0225
Provider Business Practice Location Address Fax Number:
334-287-0245
Provider Enumeration Date:
02/06/2007

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: 363LF0000X , with the licence number:  1-098539 , 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)

  • Identifier: A003932 . This is a "AR STATE LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 630503108 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5XX70 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 51536625 . This is a "BLUE CROSS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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