Healthcare Provider Details

I. General information

NPI: 1104836006
Provider Name (Legal Business Name): ELIZABETH GARRISON SALT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 FOUNTAIN CT STE 220
LEXINGTON KY
40509-2696
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-629-7265
  • Fax: 859-629-7266
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3004602
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: