MEDICARE: MICHELLE D GARRETT CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	COA.18115-NP	OH

General Provider Information

NPI Number	:	1760852289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE D GARRETT CNP

Provider Business Mailing Address
First Line	:	5982 RHODES RD
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-8100
Country	:	US
Telephone Number	:	330-673-1347
Fax Number	:	330-678-3677

Provider Business Practice Location Address
First Line	:	400 TUSCARAWAS ST W
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44702-2044
Country	:	US
Telephone Number	:	330-438-2400
Fax Number	:	330-438-3003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2015
Last Update Date	:	09/26/2015

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