Provider Demographics
NPI:1295845832
Name:GARNER, SUSAN FRETWELL (CFNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:FRETWELL
Last Name:GARNER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5312
Mailing Address - Country:US
Mailing Address - Phone:662-871-5590
Mailing Address - Fax:662-862-3014
Practice Address - Street 1:144 S THOMAS ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5312
Practice Address - Country:US
Practice Address - Phone:662-871-5590
Practice Address - Fax:662-862-3014
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR883880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051078145OtherBLUE CROSS
MS08488768Medicaid
AL051078145OtherBLUE CROSS
MS08488768Medicaid