Provider Demographics
NPI:1427395920
Name:GARST, NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:GARST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5003
Mailing Address - Country:US
Mailing Address - Phone:785-727-0126
Mailing Address - Fax:785-201-1194
Practice Address - Street 1:1605 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2639
Practice Address - Country:US
Practice Address - Phone:785-727-0126
Practice Address - Fax:785-201-1194
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-112991-101363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2007Medicare PIN