Healthcare Provider Details

I. General information

NPI: 1235685538
Provider Name (Legal Business Name): CHRISTIAN D GARRETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIAN DIANA GARRETT NP

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E DAWSON ST
TYLER TX
75701-2036
US

IV. Provider business mailing address

2026 S JACKSON ST
JACKSONVILLE TX
75766-5822
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-7264
  • Fax: 903-525-1254
Mailing address:
  • Phone: 903-541-4500
  • Fax: 903-541-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number812843
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number812843
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132287
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP132287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: