Healthcare Provider Details

I. General information

NPI: 1376513267
Provider Name (Legal Business Name): LISETTE MARIE GARRETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LANGDON ST
SOMERSET KY
42503-2786
US

IV. Provider business mailing address

350 LANGDON ST
SOMERSET KY
42503-2786
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-8155
  • Fax: 606-678-7548
Mailing address:
  • Phone: 606-678-8155
  • Fax: 606-678-7548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34521
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: