Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26843 | TN |
NPI | 1023653037 |
---|---|
Provider Name | Staci Garner |
First Address | Petersburg, TN 37144-8001 |
Second Address | Petersburg, TN 37144-8001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 13/11/2019 |