Healthcare Provider Details

I. General information

NPI: 1053883561
Provider Name (Legal Business Name): KEVIN FRANKLIN GARRIS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 03/19/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MAIN STREET
FULTON AL
36446
US

IV. Provider business mailing address

24B CAMDEN BYP
CAMDEN AL
36726-1770
US

V. Phone/Fax

Practice location:
  • Phone: 334-636-4823
  • Fax: 334-636-1702
Mailing address:
  • Phone: 334-882-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903078
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-174834
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: