Individual
CRYSTAL RODGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
808 S 18TH ST, CHICKASHA, OK 73018-3919
(405) 287-8416
Mailing address
808 S 18TH ST, CHICKASHA, OK 73018-3919
(405) 287-8416
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005319792
—
OK
Enumeration date
02/22/2022
Last updated
03/31/2022
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