Provider Demographics
NPI:1427421528
Name:GARRISON, CORREAL J (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CORREAL
Middle Name:J
Last Name:GARRISON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:CORREAL
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:216 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3115
Mailing Address - Country:US
Mailing Address - Phone:662-534-9042
Mailing Address - Fax:
Practice Address - Street 1:216 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3115
Practice Address - Country:US
Practice Address - Phone:662-534-9042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901410363LF0000X
MSR872043163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care