Basic Information
| Provider Information | |||||||||
| NPI: | 1487754347 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARNER | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 W 7TH ST | ||||||||
| Address2: | 182/LR | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722055446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012572531 | ||||||||
| FaxNumber: | 5012572501 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 W MARKHAM ST | ||||||||
| Address2: | UAMS #783 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722057101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016868000 | ||||||||
| FaxNumber: | 5015266562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 07/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | E-0552 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 128689001 | 05 | AR | MEDICAID | P00361480 | 01 | AR | RAILROAD MEDICARE | OTHER |