Healthcare Provider Details

I. General information

NPI: 1376492793
Provider Name (Legal Business Name): PHILIP SPENCER GARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 10/07/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6178 COLLEGE STATION DR
WILLIAMSBURG KY
40769-1372
US

IV. Provider business mailing address

6178 COLLEGE STATION DR
WILLIAMSBURG KY
40769-1372
US

V. Phone/Fax

Practice location:
  • Phone: 859-533-7568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTA3918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: