Provider Demographics
NPI:1154479236
Name:GARNER, KATHY MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MARIE
Last Name:GARNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1157
Mailing Address - Country:US
Mailing Address - Phone:256-494-4646
Mailing Address - Fax:256-494-4649
Practice Address - Street 1:300 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1157
Practice Address - Country:US
Practice Address - Phone:256-494-4646
Practice Address - Fax:256-494-4649
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 1-068901363LF0000X
AL1-068901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1154479236 / 109271Medicaid
AL1154479236 / 192686Medicaid
AL515-95252OtherAL BCBS
AL1154479236 / 109271Medicaid
AL1154479236 / 192686Medicaid