Provider Demographics
NPI:1740928068
Name:ROYSTER, NATHANIEL ALLEN (CNP)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:ALLEN
Last Name:ROYSTER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E 8TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2545
Mailing Address - Country:US
Mailing Address - Phone:614-599-5158
Mailing Address - Fax:
Practice Address - Street 1:90 E 8TH AVE APT 7
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2545
Practice Address - Country:US
Practice Address - Phone:614-599-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily