Healthcare Provider Details

I. General information

NPI: 1285541961
Provider Name (Legal Business Name): VALARIE GAY FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 VETERANS PKWY N
MOULTRIE GA
31788-4171
US

IV. Provider business mailing address

358 VETERANS PKWY N
MOULTRIE GA
31788-4171
US

V. Phone/Fax

Practice location:
  • Phone: 229-891-3513
  • Fax: 229-890-1986
Mailing address:
  • Phone: 229-891-3513
  • Fax: 229-890-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP198535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: