Provider Demographics
NPI:1952312803
Name:GARNER, MARTHA JACQULYN (MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JACQULYN
Last Name:GARNER
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:JACQULYN
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4136 SUNNY MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-0401
Mailing Address - Country:US
Mailing Address - Phone:901-386-3269
Mailing Address - Fax:901-577-7286
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-577-7286
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN0000036101OtherRN LICENSE
TNAPN0000005193OtherNURSE PRACTITIONER LIC