Provider Demographics
NPI:1821398678
Name:GARNER, ANDREW N (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:N
Last Name:GARNER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4566
Mailing Address - Country:US
Mailing Address - Phone:573-331-7910
Mailing Address - Fax:573-331-7919
Practice Address - Street 1:1723 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4566
Practice Address - Country:US
Practice Address - Phone:573-331-7910
Practice Address - Fax:573-331-7919
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010034380364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010034380OtherFNP LICENSE