Provider Demographics
NPI:1013358522
Name:GARNER, DEENA DAVON (DNP, APRN)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:DAVON
Last Name:GARNER
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9627
Mailing Address - Country:US
Mailing Address - Phone:501-860-2927
Mailing Address - Fax:
Practice Address - Street 1:5401 JOHN F KENNEDY BLVD STE E-1
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6756
Practice Address - Country:US
Practice Address - Phone:501-860-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003913363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA003913OtherAPN LICENSE
AR3717OtherPAC
AR3717OtherPAC