Provider Demographics
NPI:1851635502
Name:GARRETT, KIM NOREEN (APRN)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:NOREEN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 BRADACH RD
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-8041
Mailing Address - Country:US
Mailing Address - Phone:218-365-8016
Mailing Address - Fax:
Practice Address - Street 1:1703 BRADACH RD
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-8041
Practice Address - Country:US
Practice Address - Phone:218-365-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-163989-4363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care