Healthcare Provider Details

I. General information

NPI: 1710342456
Provider Name (Legal Business Name): NECIA JO GARRETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 N ELM ST STE 201
HENDERSON KY
42420-2767
US

IV. Provider business mailing address

1413 N ELM ST STE 201
HENDERSON KY
42420-2767
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-8662
  • Fax: 270-826-8220
Mailing address:
  • Phone: 270-827-8662
  • Fax: 270-826-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009971
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: