Provider Demographics
NPI:1528422763
Name:GARRETT, MARCIA REBEKAH (FNP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:REBEKAH
Last Name:GARRETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:PALMER
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:510 HIGHWAY 322
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4717
Mailing Address - Country:US
Mailing Address - Phone:662-624-4292
Mailing Address - Fax:662-624-4354
Practice Address - Street 1:216 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2311
Practice Address - Country:US
Practice Address - Phone:662-563-1858
Practice Address - Fax:662-563-0617
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901364261QF0400X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner