Healthcare Provider Details

I. General information

NPI: 1427079631
Provider Name (Legal Business Name): JENNI LEA GARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1423
US

IV. Provider business mailing address

1935 BLUEGRASS AVE
LOUISVILLE KY
40215-1145
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8600
  • Fax: 502-589-8771
Mailing address:
  • Phone: 502-589-1100
  • Fax: 502-589-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2045
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: