Healthcare Provider Details

I. General information

NPI: 1346624863
Provider Name (Legal Business Name): LIANE MARIE GARRETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 ALEXANDRIA WAY
HIGHLAND HEIGHTS KY
41076-1511
US

IV. Provider business mailing address

2300 CHAMBER CENTER DR SUITE 200
LAKESIDE PARK KY
41017-1686
US

V. Phone/Fax

Practice location:
  • Phone: 859-757-0434
  • Fax: 859-441-0906
Mailing address:
  • Phone: 859-757-0434
  • Fax: 859-441-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009647
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28190717A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: