Healthcare Provider Details

I. General information

NPI: 1295599793
Provider Name (Legal Business Name): MICHAELA ELIZABETH GARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA BEAM

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SUWANNEE TRAIL ST
BOWLING GREEN KY
42103-7956
US

IV. Provider business mailing address

380 SUWANNEE TRAIL ST
BOWLING GREEN KY
42103-7956
US

V. Phone/Fax

Practice location:
  • Phone: 270-901-5000
  • Fax:
Mailing address:
  • Phone: 270-901-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: