Provider Demographics
NPI:1457837916
Name:ROGERS, CRYSTAL STARR (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:STARR
Last Name:ROGERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 BOYERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:SADIEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40370-9702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST RM C225
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1816
Practice Address - Country:US
Practice Address - Phone:859-323-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily