GARNET HEALTH PROVIDER LLC (NPI# 1336503564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336503564 |
| Entity Type | Organization |
| Organization Name | GARNET HEALTH PROVIDER LLC |
| Practice Address |
4493 Potters Cross Dr Memphis TN 38125-4421 |
| Mailing Address |
Po Box 381531 Germantown TN 38183-1531 |
| Practice Telephone | 9013368486 |
| Mailing Telephone | 9014171779 |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2016-07-27 |
| Authorized Official Name | LIESL R BULLEN (SOLE MEMBER/PROVIDER) |
| Authorized Official Telephone | 9017580280 |
| Authorized Official Credential | APN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
11962 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | Q020954 | 05 |
| Street Address |
4493 POTTERS CROSS DR |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38125-4421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144798448 | Ronald Penn Jr. | Day Training, Developmentally Disabled Services | 4751 Harvest Park Dr., Memphis, TN 38125 | 2018-11-05 |
| 1417458944 | Crestwyn Health Group, LLC | Psychiatry & Neurology | 9485 Crestwyn Hills Cv, Memphis, TN 38125 | 2018-02-21 |
| 1982121323 | Ruthie Rayford | Non-emergency Medical Transport (VAN) | 7244 Grande Bay Cove, Memphis, TN 38125 | 2017-08-25 |
| 1952769119 | Crestwyn Health Group, LLC | Psychiatric Hospital | 9485 Crestwyn Hills Cove, Memphis, TN 38125 | 2016-02-03 |
| 1033590500 | Katherine Brown | Optometrist | 7706 Winchester Road, Suite 105, Memphis, TN 38125 | 2015-06-10 |
| 1073856514 | Quaneshia R Farris | Nurse Practitioner | 7685 Winchester Rd Ste 100, Memphis, TN 38125 | 2013-04-03 |
| 1225379811 | Americare At Southbreeze Assisted Living, LLC | Assisted Living Facility | 3168 Hacks Road Cross, Memphis, TN 38125 | 2013-03-07 |
| 1780934281 | Freds Stores of Tennessee Inc | Pharmacy | 7143 Winchester Rd, Memphis, TN 38125 | 2012-09-12 |
| 1174893598 | Andi Marie Anderson | Nurse Anesthetist, Certified Registered | 3340 Players Club Parkway, Suite 350, Memphis, TN 38125 | 2012-01-02 |
| 1285938266 | Melita Robbins | Behavioral Analyst | 8922 E. Trophy Way, Ste 202, Memphis, TN 38125 | 2011-01-05 |
| Find all providers in zip 38125 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063034429 | Jared Garrison | Nurse Practitioner | 700 Harbor Edge Dr Apt 102, Memphis, TN 38103-5840 | 2020-05-08 |
| 1306493887 | Amber Nicole Madison | Nurse Practitioner | 2002 Court Ave, Memphis, TN 38104-2703 | 2019-08-20 |
| 1447605753 | Anne Wheeler Alexandrov | Nurse Practitioner | Uthsc College of Nursing, 920 Madison, Suite 532, Memphis, TN 38163-0001 | 2016-04-25 |
| 1083732911 | Teresa Carol Hug | Nurse Practitioner | 1325 Eastmoreland Ste 335, Memphis, TN 38104-3423 | 2007-03-27 |
| 1467069369 | Melissa Madolyn Morgan | Nurse Practitioner | 1265 Union Ave, Memphis, TN 38104-3415 | 2020-09-25 |
| 1245845247 | Callie Dugard | Nurse Practitioner | 1331 Union Ave, Memphis, TN 38104-3513 | 2020-09-15 |
| 1851906101 | Stephanie Marie Baggett | Nurse Practitioner | 877 Jefferson Ave, Memphis, TN 38103-2807 | 2020-09-14 |
| 1275148561 | Suzanne D Moyer | Nurse Practitioner | 877 Jefferson Ave, Memphis, TN 38103-2807 | 2020-09-13 |
| 1306459516 | Vladyslava Inman | Nurse Practitioner | 1265 Union Ave, Memphis, TN 38104-3415 | 2020-08-26 |
| 1073126553 | Katherine Ann Palo | Nurse Practitioner | 1265 Union Ave, Memphis, TN 38104-3415 | 2020-08-25 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.