Provider Demographics
NPI:1851412654
Name:WATERS, STEVEN GREGORY (CRNP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GREGORY
Last Name:WATERS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 OLD MACEDONIA RD
Mailing Address - Street 2:
Mailing Address - City:RAGLAND
Mailing Address - State:AL
Mailing Address - Zip Code:35131-3235
Mailing Address - Country:US
Mailing Address - Phone:205-472-2998
Mailing Address - Fax:
Practice Address - Street 1:1325 QUINTARD AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4619
Practice Address - Country:US
Practice Address - Phone:256-741-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-042228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily