Provider Demographics
NPI:1124889407
Name:GARNER, CHRISTINA DIANE (CHW-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DIANE
Last Name:GARNER
Suffix:
Gender:F
Credentials:CHW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1311
Mailing Address - Country:US
Mailing Address - Phone:573-468-4777
Mailing Address - Fax:573-468-4757
Practice Address - Street 1:153 E SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-1311
Practice Address - Country:US
Practice Address - Phone:573-468-4777
Practice Address - Fax:573-468-4757
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021003337183700000X
MO17265172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No183700000XPharmacy Service ProvidersPharmacy Technician