Provider Demographics
NPI:1659444651
Name:GARNER, BEVERLY ANN (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
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 1:519 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-6505
Mailing Address - Country:US
Mailing Address - Phone:662-327-6497
Mailing Address - Fax:
Practice Address - Street 1:602 N JEFFERSON ST
Practice Address - Street 2:MACON MEDICAL
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2242
Practice Address - Country:US
Practice Address - Phone:662-726-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR767941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112780Medicaid
MS00112780Medicaid