Healthcare Provider Details

I. General information

NPI: 1528422763
Provider Name (Legal Business Name): MARCIA REBEKAH GARRETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCIA PALMER GARRETT FNP

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HIGHWAY 51 N
BATESVILLE MS
38606-2311
US

IV. Provider business mailing address

510 HIGHWAY 322
CLARKSDALE MS
38614-4717
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-1858
  • Fax: 662-563-0617
Mailing address:
  • Phone: 662-624-4292
  • Fax: 662-624-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number901364
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number901364
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: