Provider Demographics
NPI:1235685538
Name:GARRETT, CHRISTIAN D (NP)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:D
Last Name:GARRETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:DIANA
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2026 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-5822
Mailing Address - Country:US
Mailing Address - Phone:903-541-4500
Mailing Address - Fax:903-541-4679
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-606-7264
Practice Address - Fax:903-525-1254
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX812843363LF0000X, 363LP0200X
TXAP132287363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1L1029OtherMEDICARE
TX368361703Medicaid