Provider Demographics
NPI:1023357274
Name:GARRETT, DONALD J (FNP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:GARRETT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180367
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-0367
Mailing Address - Country:US
Mailing Address - Phone:601-932-6400
Mailing Address - Fax:601-932-6437
Practice Address - Street 1:1201 HIGHWAY 49 S
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9425
Practice Address - Country:US
Practice Address - Phone:601-932-6400
Practice Address - Fax:601-932-6437
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR888688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily