Provider Demographics
NPI:1194220475
Name:ZUMMER, KATELYN GARNER (MD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:GARNER
Last Name:ZUMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S LIMESTONE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-2778
Mailing Address - Fax:859-219-8708
Practice Address - Street 1:830 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1711
Practice Address - Country:US
Practice Address - Phone:859-323-2778
Practice Address - Fax:859-257-8708
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY55829207R00000X
KYTP309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program