Provider Demographics
NPI:1710059613
Name:GARNER, BETTY ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:ANN
Last Name:GARNER
Suffix:
Gender:F
Credentials:MA
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 196
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0196
Mailing Address - Country:US
Mailing Address - Phone:928-729-8782
Mailing Address - Fax:928-729-8930
Practice Address - Street 1:FORT DEFIANCE PHS HOSPITAL
Practice Address - Street 2:CORNER OF ROUTE N12 AND N7
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK223231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94088578Medicaid
NM94088578Medicaid
AZP87484Medicare UPIN