Healthcare Provider Details

I. General information

NPI: 1629320619
Provider Name (Legal Business Name): JANICE GARTH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W HIGHWAY 146
LA GRANGE KY
40032
US

IV. Provider business mailing address

3001 W HIGHWAY 146
LA GRANGE KY
40032-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-9441
  • Fax:
Mailing address:
  • Phone: 316-390-4934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28240317A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75742
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008543
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: