=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962704122
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA C GARNER NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2010
-----------------------------------------------------
Last Update Date | 06/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6799 GREAT OAKS RD STE 250
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38138-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-821-8300
-----------------------------------------------------
Fax | 901-259-9793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6799 GREAT OAKS RD STE 250
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38138-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-261-0707
-----------------------------------------------------
Fax | 901-261-0701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 15310
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------