Provider Demographics
NPI:1528333515
Name:GARNER, AMY SUZANNE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:GARNER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUZANNE
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1809 E 13TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4419
Mailing Address - Country:US
Mailing Address - Phone:918-599-8200
Mailing Address - Fax:918-583-4678
Practice Address - Street 1:1809 E 13TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4419
Practice Address - Country:US
Practice Address - Phone:918-599-8200
Practice Address - Fax:918-583-4678
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK67302363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200426820AMedicaid
OK200426820AMedicaid