Provider Demographics
NPI:1346624863
Name:GARRETT, LIANE MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LIANE
Middle Name:MARIE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1686
Mailing Address - Country:US
Mailing Address - Phone:859-757-0434
Mailing Address - Fax:859-441-0906
Practice Address - Street 1:2885 ALEXANDRIA WAY
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1511
Practice Address - Country:US
Practice Address - Phone:859-757-0434
Practice Address - Fax:859-441-0906
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28190717A363LF0000X
KY3009647363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100386950Medicaid
KYP01559623OtherRR MEDICARE
OH0143879Medicaid
KYP01559623OtherRR MEDICARE