Garnet Health Provider LLC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

11962 Issued in TN

Legal business name

GARNET HEALTH PROVIDER LLC

Practice address

4493 Potters Cross Dr
Memphis, TN 38125-4421

Phone

(901) 336-8486

NPI assigned

Apr 13, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Liesl R Bullen, APN

Title

Sole Member/Provider

Phone

(901) 758-0280

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469577600000",
    "number": "1336503564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 381531",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381831531",
            "telephone_number": "901-417-1779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4493 POTTERS CROSS DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381254421",
            "telephone_number": "901-336-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARNET HEALTH PROVIDER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-13",
        "last_updated": "2016-07-27",
        "status": "A",
        "authorized_official_last_name": "BULLEN",
        "authorized_official_first_name": "LIESL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SOLE MEMBER/PROVIDER",
        "authorized_official_telephone_number": "901-758-0280",
        "authorized_official_credential": "APN"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "11962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q020954",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Davin Garner, PHARMD
• Martha Jacqulyn Garner, MSN, FNP
• Pamela Garner, APN
• Talia Nicole Garner, FNP
• Terri Garner
• Nicolle J Garniss, DO
• Garrett Healthcare Solutions
• Charles Garrett, CRNA
• Christian Marie Ann Garrett, DNP, APRN, CPNP-PC
• Claudia Garrett, LADAC

• Acute Care Nurse Practitioner in Memphis, TN
• Providers in Memphis, TN by specialty
• Acute Care Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.