Healthcare Provider Details

I. General information

NPI: 1407859630
Provider Name (Legal Business Name): BARRET LESSENBERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date: 05/23/2005
Reactivation Date: 06/01/2005

III. Provider practice location address

106 COLUMNS PLAZA DR
GLASGOW KY
42141-8068
US

IV. Provider business mailing address

106 COLUMNS PLAZA DR
GLASGOW KY
42141-8068
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-9390
  • Fax: 270-651-8698
Mailing address:
  • Phone: 270-651-9390
  • Fax: 270-651-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number22051
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number22051
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: