Provider Demographics
NPI:1811967896
Name:ROYSTER, SHERRY C (NP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:C
Last Name:ROYSTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 AIRPORT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3444
Mailing Address - Country:US
Mailing Address - Phone:256-234-3477
Mailing Address - Fax:256-712-2104
Practice Address - Street 1:1120 AIRPORT DR STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010
Practice Address - Country:US
Practice Address - Phone:256-234-3477
Practice Address - Fax:256-712-2104
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-063579364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL187062Medicaid