Individual
MRS. CRYSTAL GAYLE SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
2700 10TH AVE S STE 444, BIRMINGHAM, AL 35205-1250
(205) 723-0088
Mailing address
8434 WADE RD, WARRIOR, AL 35180-3064
(205) 543-6251
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-105083
AL
363LF0000X
Family Nurse Practitioner
Primary
1-105083
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-105083
ALABAMA BOARD OF NURSING LICENSE
AL
Enumeration date
04/01/2019
Last updated
05/04/2021
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