Healthcare Provider Details

I. General information

NPI: 1558361659
Provider Name (Legal Business Name): CARLA GARRISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. CARLA KESTER

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E. BRADFORD PARKWAY
SPRINGFIELD MO
65804-4213
US

IV. Provider business mailing address

1530 E. BRADFORD PARKWAY
SPRINGFIELD MO
65804-4213
US

V. Phone/Fax

Practice location:
  • Phone: 417-877-0630
  • Fax: 417-877-0695
Mailing address:
  • Phone: 417-877-0630
  • Fax: 417-877-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36789
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: