Healthcare Provider Details

I. General information

NPI: 1114112729
Provider Name (Legal Business Name): CASSANDRA ANN GARRETT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AIRPORT GARDENS RD
HAZARD KY
41701-9529
US

IV. Provider business mailing address

100 AIRPORT GARDENS RD
HAZARD KY
41701-9529
US

V. Phone/Fax

Practice location:
  • Phone: 606-377-3427
  • Fax: 606-439-6987
Mailing address:
  • Phone: 606-377-3427
  • Fax: 606-439-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03029
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: