Garrett McTyre Minor
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Jackson, MS
NPI 1114555000 · NPPES record last updated Jul 29, 2026
Key facts
- NPI
- 1114555000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- T6168 (MS)
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-1000
- NPI assigned
- Mar 28, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221202002197 | KY | Order and Referring Only - Plastic and Reconstructive Surgery |
2567831175 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | T6168 | MS | Yes |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
120 District Blvd Apt 416
Jackson, MS 39211-6388
Phone (731) 693-0932
Other providers in Jackson, MS
- Mindful Solutions, LLC
- Billy E. Mink Jr.
- Vicky Dianne Minninger
- Minor Med Care, LLC
- Candy D Minor
- Meagan A Minor
- Melissa N Minor
- Miracle Care Hospice, Inc.
- Miracle Medical Transportation LLC
- Miracle Workers Care & Companion Services LLC
All providers in Jackson, MS · Student in an Organized Health Care Education/Training Program in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.