Provider Demographics
NPI:1649206186
Name:GARITY, DEVRY (CPNP)
Entity Type:Individual
Prefix:
First Name:DEVRY
Middle Name:
Last Name:GARITY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 S LARKSPUR CIR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-8219
Mailing Address - Country:US
Mailing Address - Phone:406-529-3728
Mailing Address - Fax:
Practice Address - Street 1:4136 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7001
Practice Address - Country:US
Practice Address - Phone:907-235-8586
Practice Address - Fax:907-235-6639
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK651363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4303210Medicaid
MT4303210Medicaid
Q17529Medicare UPIN
MT000084050Medicare ID - Type Unspecified