Provider Demographics
NPI:1063407021
Name:GARNER, VIRGINIA A (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:GARNER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CURTISS ROAD, SUITE 100
Mailing Address - Street 2:ATTN: CREDENTIALS, 2 MDG
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110
Mailing Address - Country:US
Mailing Address - Phone:318-456-6124
Mailing Address - Fax:
Practice Address - Street 1:243 CURTISS ROAD, SUITE 100
Practice Address - Street 2:ATTN: CREDENTIALS, 2 MDG
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110
Practice Address - Country:US
Practice Address - Phone:318-456-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2157452363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN