Provider Demographics
NPI:1891190005
Name:GARNER, JESSICA (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 TIFFANY ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-6175
Mailing Address - Country:US
Mailing Address - Phone:903-931-1520
Mailing Address - Fax:
Practice Address - Street 1:113 TIFFANY ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-6175
Practice Address - Country:US
Practice Address - Phone:903-931-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX769362163WL0100X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant