Provider Demographics
NPI:1578226668
Name:GARNER, KIWANDA (NP)
Entity Type:Individual
Prefix:
First Name:KIWANDA
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:NP
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 746063
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6063
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:1687 CENTER POINT PKWY STE 121
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-5525
Practice Address - Country:US
Practice Address - Phone:205-557-7022
Practice Address - Fax:205-831-2849
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-16
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704257953363LF0000X
AL1-168329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily