Provider Demographics
NPI:1154903961
Name:GARNER, CAMERON RYAN
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:RYAN
Last Name:GARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 NIGHTINGALE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1007
Mailing Address - Country:US
Mailing Address - Phone:606-571-5406
Mailing Address - Fax:
Practice Address - Street 1:1615 NIGHTINGALE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1007
Practice Address - Country:US
Practice Address - Phone:606-571-5406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program